The mental health of Chinese immigrants in Birmingham, UK

Association between time of residence and self-perception of distress, interpersonal relationships, and social role in Venezuelan immigrants in Lima, Peru 2018-19: mixed-methods study

BACKGROUND

Immigrants arriving in a new country face changes that affect their social, employment, and migratory status. We carried out a mixed-methods study in the rapidly growing Venezuelan immigrant population in Lima, Peru. The objective was to determine whether there was an association between time in Peru and self-perception of symptom distress (SD), interpersonal relationships (IR), and social role (SR).

METHODS

The quantitative central component consisted of a cross-sectional study, surveying 152 participants using the Outcome Questionnaire 45.2 (OQ-45.2). The qualitative component, based on phenomenology, explored experiences and challenges during the migration process. Semi-structured in-depth interviews were conducted in 16 informants.

RESULTS

An association that was observed was the increase in the risk of clinically significant SR score with additional years of age. All informants mentioned having witnessed or experienced xenophobia in Peru. Every informant stated that significant labor differences existed between the countries. The most reported somatic symptoms were symptoms of anxiety and alterations of sleep. Additionally, no informant expressed a desire to remain in Peru long term.

CONCLUSIONS

A minority of participants registered a clinically significant total score and in each of the three domains of SD, IR, and SR. No association between months in Lima and the self-perception of distress was found. However, this could be due to the short amount of time spent in Peru and any change in self-perception might only be perceived after years or decades spent in Peru. This study is one of the first to use mixed-methods to explore the mental health of the immigrant Venezuelan population.

A focus group study of older Chinese people with CVD patients in the North West of the UK

BACKGROUND

Cardiovascular disease (CVD) is the leading cause of death for Chinese migrants around the world. Chinese CVD patients rely heavily on their native Chinese language, cultural values and beliefs, which adds challenges for the healthcare providers to offer primary healthcare services with standard protocol. The inappropriate treatment could lead to life loss, mistrust in doctor-patient relationship and heavy burden for healthcare funding.

METHODS

28 participants were included for focus group study with the grounded theory methodology.

RESULTS

There is considerable misunderstanding among the Chinese community about the role of primary care doctors in the treatment of cardiovascular disease resulting in the variable use of primary care services.

CONCLUSION

Chinese CVD patients or identified risk factors for CVD arguably need closer management, culturally sensitive advice, support and robust follow-up compared to the general population. Doctors and nurses should enhance their practice and give them confidence in their interaction with Chinese patients on the basis of how they think and behave in relation to help seeking.

Factors Influencing Suicide Behaviours in Immigrant and Ethno-Cultural Minority Groups: A Systematic Review

This paper reviews recent literature on factors influencing suicide behaviours, including thoughts, plans, and attempts, in immigrant and ethno-cultural minority groups, to inform a more comprehensive understanding of suicide behaviours in increasingly culturally diverse populations. Thirty-three studies published between 2002 and 2013 were identified through digital databases searches and included in this review. Analysis of study findings focused on impacts of ethno-cultural identity and acculturation, other cultural and immigration influences, and family and community supports on suicide behaviours. Policy, practice, and research recommendations are identified, to inform relevant suicide prevention efforts and enhance mental health supports for immigrant and ethno-cultural minority populations.

An Integrated Approach to Bias in a Longitudinal Survey in the United Kingdom: Assessing Construct, Method, and Item Bias in the General Health Questionnaire (GHQ-12)

Construct, method, and item bias are three levels of measurement bias (i.e., internal bias) essential for valid group comparisons. While many studies often focus on only one level of bias, an integrated perspective on bias is still missing, especially in longitudinal designs. The aim of this study is to address bias in an integrated manner, using four waves of data in the U.K. Longitudinal Household Panel Survey. Responses to the General Health Questionnaire (GHQ-12) from natives and two generations of immigrants were used to analyze the three levels of bias. While the basic structure of the GHQ-12 was stable across groups and time, item and method bias decreased with repeated administrations. Results were confirmed with a sensitivity test. The integrated results allowed for a distinction between temporal sources of bias that became smaller over time and sources affecting valid comparisons persistently. We discuss the implications for mental health assessment.

Satisfaction with social care: the experiences of people from Chinese backgrounds with physical disabilities

The satisfaction of social care among service users provides an important indication of how services are performing. Although there is evidence to suggest that people from black and minority ethnic communities experience less satisfaction with social care than majority groups, there is little literature which focuses specifically on people from Chinese backgrounds in England. This article provides an opportunity to hear the voices of people from Chinese backgrounds and their experiences of social care for a physical disability. Individual semi-structured interviews and focus groups were conducted in 2012 and 2013 respectively with people from Chinese backgrounds who lived in England, were aged between 18 and 70, and received social care for a physical disability. Interview and focus group transcripts were analysed using a thematic approach. The findings show that language difference created a structural barrier for most participants to negotiating access to and navigating through social care. Language difference and the cultural expectation that families should look after their own were main factors that explained their late utilisation of social care. Because of limited social support, many families struggled to meet the long-term care needs of their relative with a physical disability and hence initially welcome the input of social care. However, many found that social care could not adequately meet their needs but did not feel that they had the right to voice their dissatisfaction. They would either stop using social care services or become more reliant on their family for support. Chinese welfare organisations play a crucial role to meet the cultural and linguistic needs of people from Chinese backgrounds. Closer collaboration between local authorities and Chinese welfare organisations is needed to enable an effective use of social care and community resources to meet the needs of people from Chinese backgrounds with physical disabilities.

Self-harm amongst people of Chinese origin versus White people living in England: a cohort study

BACKGROUND

There has been little previous research on self-harm among people of Chinese origin living in the UK, although this population has grown substantially in recent years and China is now the largest source of international students at UK universities.

METHODS

We conducted a prospective cohort study using self-harm presentation data (1997-2011) collected from three hospitals in the City of Manchester, which has the largest Chinese population across all UK Local Authorities. Rate ratios between the Chinese and White groups were calculated using Poisson regression models. Chi-square tests (or Fisher's exact tests), logistic regression, and log-binomial regression were used to examine differences in characteristics and clinical management between groups.

RESULTS

Ethnicity was known in the study cohort for 23,297 (87%) amongst 26,894 individuals aged 15 years and above. A total number of 97/23,297 (0.4%) people of Chinese ethnic origin presented with self-harm over the study period and 20,419 (88%) were White people. Incidence of self-harm in the Chinese group (aged 16-64 years) was less than one fifth of that found in White people (0.6 versus 3.2 per 1000 person-years; rate ratio 0.18, 95% confidence interval 0.13-0.24), and was particularly low amongst men of Chinese origin. Individuals of Chinese origin who presented with self-harm were younger, more likely to be female and students, and more likely to self-injure and describe relationship problems as a precipitant than White people. They were less likely to have clinical risk factors such as drug/alcohol misuse and receiving psychiatric treatment, and were rated to have lower risk of self-harm repetition by treating clinicians.

CONCLUSION

Future research needs to investigate whether the low incidence of self-harm presenting to hospitals amongst people of Chinese origin truly reflects a lower frequency of self-harm, or alternatively is due to markedly different post-episode help-seeking behaviours or student overrepresentation in this ethnic group. Relevant healthcare professionals need to be aware of the risk characteristics of people of Chinese origin who self-harm.

Being healthy: a grounded theory study of help seeking behaviour among Chinese elders living in the UK

The health of older people is a priority in many countries as the world's population ages. Attitudes towards help seeking behaviours in older people remain a largely unexplored field of research. This is particularly true for older minority groups where the place that they have migrated to presents both cultural and structural challenges. The UK, like other countries, has an increasingly aging Chinese population about who relatively little is known. This study used a qualitative grounded theory design following the approach of Glaser (1978). Qualitative data were collected using semi-structured interviews with 33 Chinese elders who were aged between 60 and 84, using purposive and theoretical sampling approaches. Data were analysed using the constant comparative method until data saturation occurred and a substantive theory was generated. “Being healthy” (the core category) with four interrelated categories: self-management, normalizing/minimizing, access to health services, and being cured form the theory. The theory was generated around the core explanations provided by participants and Chinese elders’ concerns about health issues they face in their daily life. We also present data about how they direct their health-related activities towards meeting their physical and psychological goals of being healthy. Their differential understanding of diseases and a lack of information about health services were potent predictors of non–help seeking and “self” rather than medical management of their illnesses. This study highlights the need for intervention and health support for Chinese elders.

Chinese Elders' views on their interactions in general practice: a Grounded Theory study

OBJECTIVES

The Chinese ethnic population are among the UK's largest visible minority but there is limited evidence about this population, their views about their interactions with General Practitioners (GPs) and how this impacts on their health. This study aimed to explore Chinese Elders' experiences of and attitudes towards the provision of health services in primary care.

DESIGN

The method of investigation was a Grounded Theory study using open-ended in-depth interviews. Purposive and theoretical sampling was used to recruit thirty-three Chinese Elders from Chinese communities in the North West of England. Face-to-face interviews were conducted and audio-recorded; transcripts were translated, back translated, analysed and coded by all members of the research team to identify concepts following the Grounded Theory approach. Themes were generated from the data and were used to guide the study into the theoretical sampling phase of the investigation.

RESULTS

Chinese Elders were inclined to present to GPs only when health concerns were perceived as serious. This was defined as being beyond their ability to self-manage. Elders tended to adopt self-management strategies rather than follow professional advice. This was mainly due to communication difficulties, poor understanding of the advice doctors gave, and the way that Chinese patients interpreted and used the advice they were given. Chinese Elders reported that the purpose of contacting doctors was to obtain medicines. They presumed that once medication had been prescribed their symptoms would be cured, and then they believed that they could self-manage their health, usually without further GP or other medical follow up.

CONCLUSION

These data suggest that significant misunderstandings between Chinese Elders and GPs exist. The findings highlight the dissatisfaction expressed by Elders regarding their interactions with UK health professionals. Chinese Elders' perceptions are influenced by the way Chinese people think about health and illness, and also by their GPs' assumptions. These findings are of value to UK GPs and family doctors worldwide who are concerned with improving the quality of health services provided to an increasingly ageing migrant Chinese population.

Perceptions and attitudes towards exercise among Chinese elders - the implications of culturally based self-management strategies for effective health-related help seeking and person-centred care

BACKGROUND

Encouraging the uptake of physical activity among a culturally diverse elderly population presents a challenge for health-care providers across the world. Little is known about the health-care needs of these populations, for example the increasingly ageing group of Chinese elders in many parts of the world who are now facing later life and increasing challenges to their health.

OBJECTIVE

This study aimed to explore behaviours and attitudes towards exercise among older Chinese immigrants in the UK to provide insights into the health of Chinese populations in the UK and elsewhere.

DESIGN

A Grounded Theory approach using purposive and theoretical sampling with in-depth semi-structured interviews.

SETTING AND PARTICIPANTS

Chinese elders were recruited from Chinese communities in the North West of England. Thirty-three participants were interviewed face-to-face and audio-recorded.

RESULTS

Participants self-managed exercise based on cultural perceptions of health and ingrained Chinese values. Professional support and information was lacking and relied on folk norms rather than person-centred recommendations for healthy living. Inappropriate exercise regimes could act as a substitute for seeking health-related advice when exercise was often used as a self-monitored barometer to assess their perceived health status.

DISCUSSION AND CONCLUSION

Chinese elders may undertake inappropriate exercise, leading to high-risk situations, if appropriate professional information is not provided. Health-care practitioners should devote attention to understanding Chinese elders' attitudes towards exercise, as this may ultimately lead to successful health promotion activities. A person-centred approach that acknowledges and works with self-management practices is advocated.

Limited English proficiency and psychological distress among Latinos and Asian Americans

English proficiency is increasingly recognized as an important factor that is related to the mental health of immigrants and ethnic minorities. However, few studies have examined how the association between English proficiency and mental health operates and whether the pattern of association is similar or different among various ethnic minority groups. This paper investigates how limited English proficiency directly and indirectly affects psychological distress through pathways of discrimination for both Latinos and Asian Americans in the United States. Findings suggest that, for Asian Americans, limited English proficiency has an independent relationship with psychological distress over and above demographic variables, socioeconomic and immigration-related factors and discrimination. For Latinos, however, socio-demographic variables and discrimination show a stronger association than limited English proficiency in affecting psychological distress. Different forms of discrimination - everyday discrimination and racial/ethnic discrimination - are equally important for both ethnic groups. Findings underscore the differential role of limited English proficiency for the mental health of Asian Americans and Latinos and suggest the distinctive racial experiences and backgrounds of these two ethnic groups.

Depressive symptoms in Chinese factory workers in Nagasaki, Japan

The number of foreign workers in Japan, especially temporary workers, has been increasing recently. However, little is known about the mental health status of the foreign workers working temporarily in Japan. We examined the depressive symptoms in 81 Chinese factory workers and attempted to identify the determining factors. The subjects were requested to complete individual questionnaires on sociodemographic variables (sex, age group, and residence period in Japan), working condition variables (number of working days per week and working hours per day), health administration variables (health checkups and health education), a social support variable (interpreters at workplace), and health behavior variables (alcohol consumption, current smoking, and regular exercise). The 20-item Center for Epidemiologic Studies Depression scale (CES-D) was used to measure the depressive symptoms. Of all the subjects, 95% and 84% received health checkups and health education, respectively, at their workplaces. The results of multiple linear regression analysis showed that long working hours per day were significantly associated with high CES-D score. Further, we found that older age (30-49 yr) was marginally associated with high CES-D score. Health administration considering working time and age would be important for decreasing depressive symptoms among foreign workers.