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Tuffour I. 'They tried to evil me': An explanatory model for Black Africans' mental health challenges. Nurs Inq 2024; 31:e12602. [PMID: 37735926 DOI: 10.1111/nin.12602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 09/23/2023]
Abstract
This paper explores the explanatory models of mental challenges among Black Africans in England. It argues that understanding these models is critical for providing culturally appropriate care to this population. The study employed qualitative methodology, and interpretative phenomenological analysis (IPA). Twelve mental health service users who are living in England and self-identified as first or second-generation Black Africans were purposively selected. The data were gathered using face-to-face semistructured interviews. Data were manually analysed in accordance with IPA concepts of searching for common, unique and idiosyncratic themes across transcripts. The findings revealed three themes Black Africans associated to their explanatory model of mental health challenges: complexities of migration, African-centred worldview and negative life experiences. To help alleviate the Eurocentric nature of mental health practice in England, it is hoped that this explanatory model will become an integral part of mental health practice in England and around the world.
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Affiliation(s)
- Isaac Tuffour
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK
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2
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Subandi MA, Praptomojati A, Marchira CR, DelVecchio Good MJ, Good BJ. Cultural explanations of psychotic illness and care-seeking of family caregivers in Java, Indonesia. Transcult Psychiatry 2021; 58:3-13. [PMID: 32290788 DOI: 10.1177/1363461520916290] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The cultural understanding of illness among caregivers of first-episode psychotic persons is a crucial issue. Not only does it influence caregivers' care-seeking behavior and length of time until receiving medical treatment (known as the 'duration of untreated psychosis' or DUP), but it also predicts the outcome of the illness. This article aims to explore cultural understanding and care-seeking behavior among caregivers of psychotic patients in Java, Indonesia. Data for this article have been taken from two studies conducted by our research group in Yogyakarta, Indonesia. Methods of data collection include surveys, case studies, ethnographic fieldwork, and in-depth interviews. Results of analyses, within and across studies, indicate that caregivers have employed diverse cultural explanatory models in order to understand psychotic illness. Local cultural beliefs, including possession and forms of black magic, were among the most common initial concepts held by family members in relation to psychosis. This echoes broader cultural beliefs in Java. However, it was not uncommon for caregivers to also understand illness in psychological terms (such as frustration, disappointment, and stress) and attached medical explanations. Caregivers' understanding of illness also changed over time following the changing course of the illness. Both models of illness and the rapidity of care-seeking are also related to the acuteness of onset. This article concludes that it is important for mental health providers, as well as those designing systems of care, to understand the diversity and changing nature of caregivers' cultural understanding of psychotic illness.
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Read J. Bad things happen and can drive you crazy: The causal beliefs of 701 people taking antipsychotics. Psychiatry Res 2020; 285:112754. [PMID: 32086059 DOI: 10.1016/j.psychres.2020.112754] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/28/2019] [Accepted: 01/01/2020] [Indexed: 01/22/2023]
Abstract
In almost all countries the public prefers psycho-social explanations of 'schizophrenia' to bio-genetic ones. The causal explanations of people who experience psychosis have been under-researched, and, if they diverge from the dominant bio-genetic paradigm, can be dismissed as 'lack of insight'. 701 people, from 30 countries, who completed an online survey about their experiences on antipsychotics, answered an open question about what had caused the problems for which they had been prescribed the drugs. On a 'Bio-Social' likert scale, from 1 = 'Purely Biological' to 5 = 'Purely Social', the mean score was 4.24. Thematic analysis of 1,063 causal statements produced seven themes: Social (49.9%), Psychological (12.1%), Bio-genetic (11.6%), Iatrogenic (11.3%), Drug and Alcohol (6.7%), Medical Condition (4.5%) and Insomnia (4.0%). Respondents were 13 times more likely to report predominantly or exclusively Social causes as to report predominantly or exclusively Bio-genetic causes. Those with a psychosis diagnosis were even more likely than others to report a Social cause. The causal beliefs of this sample are consistent with previous studies of people diagnosed with 'schizophrenia' and the beliefs of the public. They are also aligned with recent research into the social causes of psychosis. It is argued that rather than dismiss the beliefs as 'lack of insight' it is more respectful and productive to listen carefully and adjust our understandings and services accordingly.
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Affiliation(s)
- John Read
- School of Psychology, University of East London, London E15 4LZ, UK.
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4
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Mathews M, Bhola P, Herbert H, Chaturvedi SK. Explanatory models of mental illness among family caregivers of persons in psychiatric rehabilitation services: A pilot study. Int J Soc Psychiatry 2019; 65:589-602. [PMID: 31385555 DOI: 10.1177/0020764019866228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Understanding the explanatory models of family caregivers is particularly important in interdependent contexts like India, where they often play a significant role in the help-seeking behaviours, treatment decision-making and long-term care of those diagnosed with mental illness. AIMS This study was planned to explore the diversity of explanatory models among family caregivers at a centre for recovery-oriented rehabilitation services in South India. METHODS The sample for this study included 60 family caregivers of patients referred to Psychiatric Rehabilitation Services within a tertiary-care hospital for mental health and neurosciences. Bart's Explanatory Model Inventory, including a semi-structured interview and a checklist, assessed the family caregivers' explanatory model of distress on five domains: identity, cause, timeline, consequences and control/cure/treatment. RESULTS The results indicated the coexistence of multiple causal explanatory models including psychosocial, supernatural, situational and behavioural contributors. While 36.7% of the caregivers displayed two explanatory models, 33.3% of the caregivers held three explanatory models and 16.6% of the caregivers endorsed four explanatory models. Caregivers shared their concerns about varied consequences of mental illness but less than half of them were aware of the name of the psychiatric disorder. While they accessed various forms of treatments and adjunctive supports such as prayer, medication was the most frequently used treatment method. CONCLUSIONS The findings have implications for collaborative goal setting in recovery-oriented services for persons with mental illness and their families.
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Affiliation(s)
- Manila Mathews
- 1 Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Poornima Bhola
- 1 Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Hesi Herbert
- 1 Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Santosh K Chaturvedi
- 2 Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
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Tuffour I, Simpson A, Reynolds L. Mental illness and recovery: an interpretative phenomenological analysis of the experiences of Black African service users in England. J Res Nurs 2019; 24:104-118. [PMID: 34394513 DOI: 10.1177/1744987118819667] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Research conceptualising recovery is predominantly Eurocentric. This paper develops the conceptualisation of recovery by Black African service users. Aims Our aim was to explore Black African service users' experiences of recovery from mental illness and to understand how they conceptualise recovery. Methods Using a qualitative research approach and interpretative phenomenological analysis (IPA), semi-structured interviews were conducted with 12 Black African service users recovering from mental illness in England. Results Participants conceptualised recovery as a pragmatic and subjective concept distributed across a continuum of clinical, functional and spiritual dimensions, resilience, identity and their social and cultural backgrounds. Conclusions It seems critical for all stakeholders to ensure that these components are embedded in recovery-oriented services for Black African service users.
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Affiliation(s)
- Isaac Tuffour
- Faculty of Education, Health, and Wellbeing, University of Wolverhampton, UK
| | - Alan Simpson
- Division of Nursing, School of Health Sciences, City University of London, UK
| | - Lisa Reynolds
- Division of Nursing, School of Health Sciences, City University of London, UK
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Carter L, Read J, Pyle M, Law H, Emsley R, Morrison A. Causal beliefs in people experiencing psychosis: The relationship to treatment accessed and the perceived helpfulness of treatment. Psychol Psychother 2018; 91:332-344. [PMID: 29194921 DOI: 10.1111/papt.12163] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 09/29/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE Research suggests that the way an individual understands a health difficulty can influence their subsequent behaviour. The aim of this study was to explore the psychometric properties of a new causal belief questionnaire for people who have experience of psychosis. We also planned to provide an overview of current causal beliefs within this group and to explore the relationship between these beliefs and the perceived helpfulness of treatment and the treatment accessed. METHODS Three hundred and eleven service-users with experience of psychosis completed a questionnaire designed to explore how they understand the cause of their difficulties. Additional information was collected about different aspects of treatment. RESULTS The results of the exploratory factor analysis indicated a two-factor solution comprising a psychosocial and biogenetic scale. Individuals in this study endorsed a variety of different causes, with an overall preference for psychosocial explanations. No relationships were established between beliefs and perceptions about the helpfulness of treatment. Individuals who had accessed cognitive behavioural therapy were more likely to endorse the psychosocial factor. CONCLUSIONS Individuals with psychosis consider a number of factors to be important in relation to the development of their experiences. These beliefs should be explored as part of the therapeutic process as this appears to be important to the individual and could potentially help inform treatment decisions. PRACTITIONER POINTS The causal belief questionnaire captured two underlying constructs relating to psychosocial and biogenetic causes. Individuals within this group endorsed a range of factors; however, they prefer psychosocial causes overall. There was an indication that some aspects of an individual's beliefs were associated with the treatment they accessed.
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Affiliation(s)
- Lucy Carter
- School of Psychological Sciences, The University of Manchester, UK.,Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, UK
| | - John Read
- Clinical Psychology, University of East London, Stratford, UK
| | - Melissa Pyle
- Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, UK
| | - Heather Law
- Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, UK
| | - Richard Emsley
- Centre for Biostatistics and MAHSC Trials Co-ordination Unit, School of Health Sciences, The University of Manchester, Manchester Academic Health Science Centre, UK
| | - Anthony Morrison
- School of Psychological Sciences, The University of Manchester, UK.,Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, UK
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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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Giacco D, Laxhman N, Priebe S. Prevalence of and risk factors for mental disorders in refugees. Semin Cell Dev Biol 2017; 77:144-152. [PMID: 29174456 DOI: 10.1016/j.semcdb.2017.11.030] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 11/03/2017] [Accepted: 11/21/2017] [Indexed: 10/18/2022]
Abstract
Given the increasing numbers of refugees worldwide, the prevalence of their mental disorders is relevant for public health. Prevalence studies show that, in the first years of resettlement, only post-traumatic stress disorder (PTSD) rates are clearly higher in refugees than in host countries' populations. Five years after resettlement rates of depressive and anxiety disorders are also increased. Exposure to traumatic events before or during migration may explain high rates of PTSD. Evidence suggests that poor social integration and difficulties in accessing care contribute to higher rates of mental disorders in the long-term. Policy and research implications are discussed.
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Affiliation(s)
- Domenico Giacco
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, United Kingdom.
| | - Neelam Laxhman
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, United Kingdom
| | - Stefan Priebe
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, United Kingdom
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9
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Yalvaç HD, Mutlu EA, Kotan Z, Özer İ, Karslıoğlu EH, Çayköylü A. Explanatory Models of Illness, Help Seeking Behaviours and Related Factors in Patients with Schizophrenia: A Comparative Study from Two Different Provinces of Turkey. Community Ment Health J 2017; 53:951-957. [PMID: 27900651 DOI: 10.1007/s10597-016-0074-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 11/24/2016] [Indexed: 11/26/2022]
Abstract
This study aims to identify the help seeking behaviours of patients from two geographically distinct provinces of Turkey. A questionnaire about sociodemographic characteristics and help seeking ways was applied to 49 schizophrenia patients from Van, 99 from Ankara. The ratio of patients seeking psychiatric help at the beginning of their illness was 76% in Ankara, the capital city, in contrast to 54% in Van (p = 0.01). Twenty-two percent of patients from Ankara and 69% from Van reported that non-psychiatric help seeking was the choice of their families (p < 0.001). Thirty-five percent of all patients sought religious support when their symptoms started. Patients with lower education levels sought more religious help (p = 0.002). Help seeking behaviours show regional variations. Religious help seeking behaviour is a major way of dealing with the illness. Psychoeducation is a crucial need both for patients and families.
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Affiliation(s)
- Hayriye Dilek Yalvaç
- Psychiatry Department, Dr. AY Ankara Oncology Training and Research Hospital, Ankara, Turkey.
| | | | - Zeynep Kotan
- Psychiatry Department, Dr. AY Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - İbrahim Özer
- Psychiatry Department, Dr. AY Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Ersin Hatice Karslıoğlu
- Psychiatry Department, Dr. AY Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Ali Çayköylü
- Department of Psychiatry, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
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Carter L, Read J, Pyle M, Law H, Morrison AP. Mental health clinicians' beliefs about the causes of psychosis: Differences between professions and relationship to treatment preferences. Int J Soc Psychiatry 2017; 63:426-432. [PMID: 28552026 DOI: 10.1177/0020764017709849] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Previous evidence suggests that how an individual conceptualises the cause of a health problem can impact on subsequent perceptions and behaviour. AIMS This study explored the beliefs about the causes of psychosis in a group of mental health professionals. The study also sought to examine the relationship between causal beliefs and the perceived helpfulness of different treatments. METHODS A total of 219 clinicians completed a questionnaire about the provision of cognitive behavioural therapy (CBT) and antipsychotic medication for their clients who were experiencing psychosis and their opinions about the helpfulness of these treatments. Causal beliefs were also assessed. RESULTS AND CONCLUSIONS Clients were twice as likely to be offered medication compared to CBT. Clinicians held a multifactorial model of aetiology, but were more likely to endorse psychosocial causes than biological factors. Clinicians with psychosocial beliefs were more likely to rate CBT as effective, whereas those with biological models were more likely to endorse the helpfulness of medication. Clinicians adopt a multi-causal approach when conceptualising the aetiology of psychosis and these beliefs were related to opinions about the helpfulness of treatment. Beliefs about the aetiology of their client's experiences could blind clinicians to the benefits of offering different approaches.
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Affiliation(s)
- Lucy Carter
- 1 Division of Psychology and Mental Health, School of Health Sciences, The University of Manchester, Manchester, UK.,2 Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - John Read
- 3 School of Psychology, University of East London, Stratford Campus, London, UK
| | - Melissa Pyle
- 2 Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Heather Law
- 2 Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Anthony P Morrison
- 1 Division of Psychology and Mental Health, School of Health Sciences, The University of Manchester, Manchester, UK.,2 Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Carter L, Read J, Pyle M, Morrison AP. The Impact of Causal Explanations on Outcome in People Experiencing Psychosis: A Systematic Review. Clin Psychol Psychother 2016; 24:332-347. [PMID: 26805779 DOI: 10.1002/cpp.2002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 11/26/2015] [Accepted: 11/29/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Lucy Carter
- The University of Manchester; Manchester UK
- Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust; Manchester UK
| | - John Read
- Swinburne University; Melbourne Australia
| | - Melissa Pyle
- Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust; Manchester UK
| | - Anthony P. Morrison
- The University of Manchester; Manchester UK
- Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust; Manchester UK
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12
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Bhikha A, Farooq S, Chaudhry N, Naeem F, Husain N. Explanatory models of psychosis amongst British South Asians. Asian J Psychiatr 2015; 16:48-54. [PMID: 26232352 DOI: 10.1016/j.ajp.2015.05.042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 05/25/2015] [Accepted: 05/26/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE A strong interest in the understanding, exploring, and extracting explanatory models of psychosis has recently arisen. Explanatory models (EMs) offer justifications and propose explanations when coping with and treating illnesses. Therefore, they may be important predictors of clinical outcome. Explanatory models of psychosis have been explored in many non-Western countries. However, very little research has examined EMs of psychosis in the UK. We therefore, aimed to elicit and describe explanatory models of psychosis amongst British South Asians, using both quantitative and qualitative methods. METHOD EMs of psychosis were examined using the Short Explanatory Model Interview (SEMI) in a cross-sectional sample of 45 patients. RESULTS Most patients (55.5%) attributed their illness to supernatural causes. Few patients cited a biological (4.4%) cause. Majority of patients held dual EMs of psychosis (77.7%), combining prescribed medication and seeing a traditional healer as a treatment method. Duration of Untreated Psychosis (DUP) was not significantly associated with EMs of psychosis. CONCLUSION The results suggest that patients hold multi-explanatory models in order to make sense of their illness and these stem from deep rooted traditional beliefs. This highlights the importance of educational intervention, culturally adapted psychological interventions and possibly working together with traditional healers in the UK to provide a positive support system. Further work is required in order to fully understand the relationship between EMs of psychosis and DUP.
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Affiliation(s)
- Aqeela Bhikha
- University of Manchester, Institute of Brain, Behaviour, and Mental Health, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, United Kingdom.
| | - Saeed Farooq
- Staffordshire University & Consultant Psychiatrist Black County Partnership, NHS Foundation Trust, Staffordshire University, BL167, Blackheath Lane, Beaconside, ST18 0AD, Staffordshire, United Kingdom.
| | - Nasim Chaudhry
- Greater Manchester West Mental Health Foundation Trust and Honorary Leturer, University of Manchester, Meadowbrook Psychiatric Unit, Stott Lane, Salford M68HG, United Kingdom.
| | - Farooq Naeem
- Queens University, Kingston, & AMHS-KFLA, 385 Princess Street, Kingston, ON, Canada, K7L 1B9.
| | - Nusrat Husain
- University of Manchester, Institute of Brain, Behaviour, and Mental Health, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, United Kingdom.
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Owiti JA, Palinski A, Ajaz A, Ascoli M, De Jongh B, Bhui KS. Explanations of illness experiences among community mental health patients: an argument for the use of an ethnographic interview method in routine clinical care. Int Rev Psychiatry 2015; 27:23-38. [PMID: 25747025 DOI: 10.3109/09540261.2014.995602] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Cultural variations in perceptions of mental distress are important issues for healthcare. They can affect communication between patients and professionals and may be a root cause for misdiagnosis, patient disengagement, and disparities in access, outcomes and overall experiences of treatment by patients. Taking into account patients' explanatory models (EMs) of mental distress is fundamental to patient-centred care, and improved outcomes. This paper reports on the outcomes from the Cultural Consultation Service, commissioned in an inner-city London borough. We used a narrative-based ethnographic method of assessment, in which community mental health patients referred for a cultural consultation were interviewed using Barts Explanatory Model Inventory and Checklist (BEMI) to assess the EMs of their mental distress. Patients mainly attributed the causes and consequences of their mental distress to emotional and psychological factors, which were inextricably linked to existing social concerns and interpersonal issues. Desired solutions mainly focused on treatment, social, and systemic interventions. We found that using BEMI could contribute to a comprehensive assessment in routine care and can be used by professionals within a short timeframe and with minimal training. Ethnographic assessment method captures patients' EMs and illness experiences, opening the way for patient-centred interventions and potentially better outcomes and experiences.
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Affiliation(s)
- John A Owiti
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Queen Mary, University of London , London , UK
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Bhikha AG, Farooq S, Chaudhry N, Husain N. A systematic review of explanatory models of illness for psychosis in developing countries. Int Rev Psychiatry 2012; 24:450-62. [PMID: 23057981 DOI: 10.3109/09540261.2012.711746] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Explanatory models of illness, held by patients and treating clinicians, offer justifications and propose explanations for sickness, treatment evaluations and choice. These have been studied in relation to common mental disorders but research on explanatory models of psychosis (EMOP) has received scant attention. Adequately understanding patients' explanatory models for psychosis has important clinical implications. METHOD We systematically examined studies on EMOP in the developing world to report on the nature of explanatory models, their relationship with help-seeking, duration of untreated psychosis (DUP), perceived stigma and any differences in the explanatory models between first and subsequent episodes. RESULTS 14 studies examining EMOP in developing countries were identified. The majority of studies reported predominantly supernatural and psychosocial EMOP. Holding supernatural and psychosocial explanatory models affected help-seeking behaviour, treatment modalities used and DUP. DISCUSSION EMOP in developing countries are rich and varied. The literature reports on a variety of populations using different methods and suffers from methodological limitations. Some recent studies have also attempted to modify explanatory models by using educational interventions; however, this was not examined in patient populations. Further research is needed to examine the impact of different explanatory models on DUP and help-seeking behaviours.
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Affiliation(s)
- Aqeela G Bhikha
- Psychiatry Research Group, School of Community Based Medicine, University of Manchester, UK.
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15
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What do people with psychosis think caused their psychosis? A Q methodology study. Behav Cogn Psychother 2009; 37:11-24. [PMID: 19364404 DOI: 10.1017/s1352465808004955] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND A key component of cognitive therapy for psychosis is the development of a meaningful and shared formulation of the onset of the psychosis. Therapists bring an understanding of the development of psychotic symptoms based on theoretical models and try to marry these with the person's own experience and explanations. However, an important question is whether this understanding is compatible with the explanations held by the client. AIMS This study investigated what factors people believed led to the onset of their psychosis. METHOD A Q set of potential causes for psychosis was identified from a literature search and interviews with people with differing experiences of psychosis. From this, 58 potential causes of psychosis were identified. Twenty-one people who had experienced a psychotic breakdown then ranked these explanations as possible causes. RESULTS Using Principle Components Analysis four main factors were identified as perceived causal factors for the onset of psychosis. These factors were described as: a) drug usage; b) traumatic experiences in adulthood; c) personal sensitivity; and d) developmental vulnerabilities. CONCLUSIONS This study revealed that people with psychosis have different explanatory frameworks for the onset of their difficulties. This work is helpful as this effort to understand the person's own understanding of their problems is a first stepping stone towards a collaboratively generated formulation that may be helpful in building a therapeutic alliance, engagement in treatment, and ultimately in improved outcome. It is likely that these different explanatory frameworks could lend themselves to different treatment approaches.
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Rüdell K, Bhui K, Priebe S. Concept, Development and Application of a New Mixed Method Assessment of Cultural Variations in Illness Perceptions. J Health Psychol 2009; 14:336-47. [DOI: 10.1177/1359105308100218] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In urban inner city areas, health professionals meet many individuals from diverse cultural groups that they need to understand, assess and treat effectively. This article describes the concept, development and application of a new assessment tool (the Barts Explanatory Model Inventory) that aims to help health professionals determine illness perceptions and treatment preferences of distress. The article describes the tool's background in theories of illness perception, gives a brief review of currently available instruments and describes the systematic development of this new instrument. Results from the first application are discussed to determine benefits and weaknesses of the new tool.
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Affiliation(s)
| | - K. Bhui
- Queen Mary University of London, UK
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Abstract
BACKGROUND Explanatory models of illness may differ between ethnic groups and influence treatment satisfaction and compliance. AIMS To compare explanatory models among people with schizophrenia from four cultural backgrounds and explore their relationship with clinical and psychological characteristics. METHOD Explanatory models, insight, treatment compliance, health locus of control, quality of life, treatment satisfaction, therapeutic relationships and symptomatology were assessed in UK Whites and Bangladeshis, African-Caribbeans and West Africans. RESULTS When biological and supernatural causes of illness were compared, Whites cited biological causes more frequently than the three non-White groups, who cited supernatural causes more frequently. When biological and social causes were compared, Whites cited biological causes more frequently than African-Caribbeans and Bangladeshis, who cited social causes more frequently. A biological explanatory model was related to enhanced treatment satisfaction and therapeutic relationships but not treatment compliance. CONCLUSIONS Explanatory models of illness contribute to patient satisfaction with treatment and relationships with clinicians.
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Affiliation(s)
- Rosemarie McCabe
- Unit for Social and Community Psychiatry, Barts and the London School of Medicine, Newham Centre for Mental Health, London, UK.
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