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Wasserman JS, Holtzer R. Depressive Symptoms are Associated with Decline Over Time in Verbal Fluency Performance in Female but Not Male Community-Dwelling Older Adults. Exp Aging Res 2024; 50:360-375. [PMID: 36989442 PMCID: PMC10539484 DOI: 10.1080/0361073x.2023.2195295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 03/16/2023] [Indexed: 03/31/2023]
Abstract
OBJECTIVE The current study was designed to examine associations between depressive symptoms and longitudinal declines in category and letter fluency performance in a gender-stratified sample of older adults. METHOD Participants were community-residing older adults (females: n = 289; males: n = 233) followed annually (2011-2018) as part of a cohort study conducted at Albert Einstein College of Medicine in New York. Depressive symptoms were assessed using the Geriatric Depression Scale (GDS). Standard forms assessed category and letter fluency performance. Participants were dementia-free during study enrollment. RESULTS The presence of baseline depressive symptoms suggestive of subclinical depression was associated with a worse longitudinal decline in category fluency performance in female but not male participants. These associations remained significant when excluding participants with prevalent and incident mild cognitive impairment and incident dementia. Irrespective of gender, letter fluency performance did not decline over time and was not influenced by the presence of depressive symptoms. DISCUSSION The present study's results can aid in identification of older adults who may be at greater risk for cognitive decline, and add to the limited literature examining the influence of gender on longitudinal associations between depressive symptoms and verbal fluency performance.
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Affiliation(s)
| | - Roee Holtzer
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
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Ojurongbe S. The perceived effects of migration on the mental health of Afro-Caribbean immigrants: A narrative synthesis of qualitative studies. J Psychiatr Ment Health Nurs 2023; 30:1203-1215. [PMID: 37401613 DOI: 10.1111/jpm.12944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 04/28/2023] [Accepted: 05/21/2023] [Indexed: 07/05/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Economic and educational opportunities are usually the principal driving forces for migration. There is a large body of quantitative research studies, mainly from the U.K., supporting the high prevalence of psychiatric disorders, mainly psychotic disorders, in Afro-Caribbean immigrants which increases across generations. The process of migration and acculturation can present significant risk factors for psychiatric disorders in immigrants. Research involving members of the Black community is generally conducted with the perception that Blacks are a homogenous group, ignoring the cultural and ethnic differences among the subgroups. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: It provides a broadened understanding of the experiences, thoughts and feelings of Afro-Caribbean immigrants, and the factors within the processes of migration and acculturation that negatively impacts their mental health. It provides context to the volume of quantitative studies indicating a high prevalence of psychiatric disorders, particularly psychotic disorders, in Afro-Caribbean immigrants and their offspring. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses conducting mental health evaluations and assessments for members of the Black community should be culturally competent. Cultural competence entails an understanding of cultural beliefs, race, ethnicity and values. Additionally, knowledge of the effects of migration and acculturation as mental health risks is also important to improve mental health outcomes. Cultural competence will help reduce health disparities by increasing trust in the health care system and providers, not only for Afro-Caribbean immigrants, but all immigrant groups. ABSTRACT INTRODUCTION: There is evidence to support migration as a significant risk factor for psychiatric disorders in immigrants. Unfortunately, as an immigrant group, little is known about the mental health of Afro-Caribbean immigrants and the factors that threaten their mental health. AIM To explore the perceived effects of migration on the mental health of Afro-Caribbean immigrants. METHODS A qualitative narrative synthesis was employed to interpretively integrate 13 primary qualitative research findings. Eleven of the primary studies were conducted in the U.K., one in the U.S. and one in Canada. RESULTS The themes gleaned: (1) experiences of racism, (2) generational conflicts, (3) feelings of powerlessness, (4) limited socioeconomic resources, (5) unfulfilled expectations, (6) fragmented family and community and (7) ignoring cultural/ethnic identity. DISCUSSION The findings broadened the understanding and experiences of Afro-Caribbean immigrants and their mental health vulnerabilities as they navigate through migration and acculturation. IMPLICATIONS FOR PRACTICE Addressing the mental health of Afro-Caribbeans will require health care providers to: (1) be cognizant of their immigrant status; (2) understand how migration and acculturation influence the mental health of immigrants; (3) be aware of the ethnocultural differences among Black subgroups.
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Bradley H, Zhu Y, Duan X, Kang H, Qu B. HIV-Specific Reported Outcome Measures: Systematic Review of Psychometric Properties. JMIR Public Health Surveill 2022; 8:e39015. [PMID: 36222289 PMCID: PMC9782451 DOI: 10.2196/39015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/03/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The management of people living with HIV and AIDS is multidimensional and complex. Using patient-reported outcome measures (PROMs) has been increasingly recognized to be the key factor for providing patient-centered health care to meet the lifelong needs of people living with HIV and AIDS from diagnosis to death. However, there is currently no consensus on a PROM recommended for health care providers and researchers to assess health outcomes in people living with HIV and AIDS. OBJECTIVE The purpose of this systematic review was to summarize and categorize the available validated HIV-specific PROMs in adults living with HIV and AIDS and to assess these PROMs using the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) methodology. METHODS This systematic review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A literature search of 3 recommended databases (PubMed, Embase, and PsychINFO) was conducted on January 15, 2021. Studies were included if they assessed any psychometric property of HIV-specific PROMs in adults living with HIV and AIDS and met the eligibility criteria. The PROMs were assessed for 9 psychometric properties, evaluated in each included study following the COSMIN methodology by assessing the following: the methodological quality assessed using the COSMIN risk of bias checklist; overall rating of results; level of evidence assessed using the modified Grading of Recommendations, Assessment, Development, and Evaluation approach; and level of recommendation. RESULTS A total of 88 PROMs classified into 8 categories, assessing the psychometric properties of PROMs for adults living with HIV and AIDS, were identified in 152 studies including 79,213 people living with HIV and AIDS. The psychometric properties of most included PROMs were rated with insufficient evidence. The PROMs that received class A recommendation were the Poz Quality of Life, HIV Symptom Index or Symptoms Distress Module of the Adult AIDS Clinical Trial Group, and People Living with HIV Resilience Scale. In addition, because of a lack of evidence, recommendations regarding use could not be made for most of the remaining assessed PROMs (received class B recommendation). CONCLUSIONS This systematic review recommends 3 PROMs to assess health outcomes in adults living with HIV and AIDS. However, all these PROMs have some shortcomings. In addition, most of the included PROMs do not have sufficient evidence for assessing their psychometric properties and require a more comprehensive validation of the psychometric properties in the future to provide more scientific evidence. Thus, our findings may provide a reference for the selection of high-quality HIV-specific PROMs by health care providers and researchers for clinical practice and research.
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Affiliation(s)
| | - Yaxin Zhu
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, China
| | - Xiyu Duan
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, China
| | - Hao Kang
- Administration Department of Nosocomial Infection, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Bo Qu
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, China.,School of Public Health, China Medical University, Shenyang, China
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Antela A, Bernardino JI, de Quirós JCLB, Bachiller P, Fuster-RuizdeApodaca MJ, Puig J, Rodríguez S, Castrejón I, Álvarez B, Hermenegildo M. Patient-Reported Outcomes (PROs) in HIV Infection: Points to Consider and Challenges. Infect Dis Ther 2022; 11:2017-2033. [PMID: 36066841 DOI: 10.1007/s40121-022-00678-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/21/2022] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION The aim of this study was to reach consensus on the use of PROs (patient-reported outcome measures) in people living with HIV (PLHIV). METHODS A scientific committee of professionals with experience in PROMs methodology issued recommendations and defined the points to support by evidence. A systematic review of the literature identified the coverage, utility, and psychometric properties of PROMs used in PLHIV. A Delphi survey was launched to measure the degree of agreement with the recommendations of a group of practicing clinicians and a group of patient representatives. RESULTS Four principles and ten recommendations were issued; however, the results of the Delphi showed significant differences in the opinion between health professionals and PLHIV, and polarization within collectives, hampering consensus. CONCLUSIONS Despite a wealth of evidence on the benefit of PROMs, there are clear barriers to their use by healthcare professionals in HIV care. Intervention on these barriers is paramount to allow truly patient-centered care.
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Affiliation(s)
- Antonio Antela
- Infectious Diseases Unit, Complejo Hospitalario Universitario de Santiago (CHUS), Santiago de Compostela, Spain.
| | | | | | - Pablo Bachiller
- Internal Medicine Department, Complejo Asistencial de Segovia, Segovia, Spain
| | | | - Jordi Puig
- Hospital Universitario Germans Trias I Pujol, Fundació Lluita Contra La Sida I Les Malalties Infeccioses, Badalona, Spain
| | | | - Isabel Castrejón
- Rheumatology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Beatriz Álvarez
- HIV and Infectious Diseases Unit, Hospital Fundación Jiménez Díaz, Madrid, Spain
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Zakari NMA, Hamadi HY, Bailey CE, Jibreel EAM. Grandparents' Mental Health and Lived Experiences while Raising Their Grandchildren at the Forefront of COVID-19 in Saudi Arabia. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2022; 65:512-528. [PMID: 34545773 DOI: 10.1080/01634372.2021.1983684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 09/14/2021] [Accepted: 09/17/2021] [Indexed: 06/13/2023]
Abstract
Understanding grandparents' lived experiences and healthy aging is essential to designing efficient, effective, and safe services to support a family structure in which grandparents care for their grandchildren. However, no study to date has explored this concept in an Arab and Muslim country during a pandemic. The purpose of this study was to examine grandparents' experiences raising their grandchildren to provide recommendations for needed mental health interventions during and after COVID-19. We used a phenomenological approach to gain a detailed and in-depth understanding of the lived experiences of 15 grandparents caring for their grandchildren. This study shows the need for support service interventions (support groups, health professional support, and respite care) for grandparents in Saudi Arabia, especially during global crises like COVID-19, that enhance social distance and social isolation. Raising grandchildren affects the physical, mental, and social wellbeing of the grandparents.
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Affiliation(s)
- Nazik M A Zakari
- College of Applied Sciences, Al Maarefa University, Riyadh, Saudi Arabia
| | - Hanadi Y Hamadi
- Department of Health Administration, University of North Florida, Jacksonville, Florida, USA
| | - Chloe E Bailey
- Department of Health Administration, University of North Florida, Jacksonville, Florida, USA
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Mackenzie CS, Pankratz L. Perceived Need, Mental Health Literacy, Neuroticism and Self- Stigma Predict Mental Health Service Use Among Older Adults. Clin Gerontol 2022:1-14. [PMID: 35400301 DOI: 10.1080/07317115.2022.2058440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Older adults are the least likely age group to seek mental health services. However, few studies have explored a comprehensive range of sociodemographic, psychological, and social barriers and facilitators to seeking treatment in later life. METHODS A cross-sectional, national sample of Canadian older adults (55+, N = 2,745) completed an online survey including reliable and valid measures of predisposing, enabling, and need characteristics, based on Andersen's behavioral model of health, as well as self-reported use of mental health services. Univariate and hierarchical logistic regressions predicted past 5-year mental health service use. RESULTS Mental health service use was most strongly and consistently associated with greater perceived need (OR = 11.48) and mental health literacy (OR = 2.16). Less self-stigma of seeking help (OR = .65) and greater neuroticism (OR = 1.57) also predicted help-seeking in our final model, although their effects were not as strong or consistent across gender, marital status, and age subgroups. CONCLUSIONS The need category was crucial to seeking help, but predisposing psychological factors were also significant barriers to treatment. CLINICAL IMPLICATIONS Interventions that target older adults high in neuroticism by improving perceptions of need for treatment, mental health literacy, and self-stigma of seeking help may be particularly effective ways of improving access to mental health services.
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Affiliation(s)
- Corey S Mackenzie
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lily Pankratz
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
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McCombie C, Cort E, Gould RL, Kiosses DN, Alexopoulos GS, Howard R, Lawrence VC. Adapting and Optimizing Problem Adaptation Therapy (PATH) for People With Mild-Moderate Dementia and Depression. Am J Geriatr Psychiatry 2021; 29:192-203. [PMID: 32600788 DOI: 10.1016/j.jagp.2020.05.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 05/28/2020] [Accepted: 05/28/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To adapt and optimize problem adaptation therapy for depression in dementia by grounding it in the lives of people with dementia, caregivers and clinicians. METHODS A person-centered qualitative approach was taken to elicit the unique cognitive, psychological and social needs of people with dementia relevant to the adaptation of the intervention. A two-stage design was used: the first involved interviews and focus groups to identify priorities and concerns surrounding depression in dementia, the second trialling of the adapted intervention. PARTICIPANTS Ten people with dementia and nine caregivers participated in individual interviews, 35 healthcare practitioners and clinical academics with experience of working with dementia participated in focus groups. RESULTS The findings highlight the importance of addressing key themes that typified the experience of depression among people with dementia including: a profound sense of isolation and role loss, the feeling of being both a burden and poorly understood, polarized thinking, interpersonal tensions, diverging views among carers and people with dementia about their capabilities, and changeability in cognitive ability and mood. These themes were used to inform adaptation of the intervention manual, ensuring that its content and delivery addressed the concerns of both people with depression and dementia and those who support them. CONCLUSION Implications for PATH included a focus on facilitating open communication, supporting the continuation of valued roles, and improving confidence.
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Affiliation(s)
- Catherine McCombie
- Department of Health Services and Population Research, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Elizabeth Cort
- Division of Psychiatry, University College London, London, United Kingdom
| | - Rebecca L Gould
- Division of Psychiatry, University College London, London, United Kingdom
| | | | | | - Robert Howard
- Division of Psychiatry, University College London, London, United Kingdom
| | - Vanessa C Lawrence
- Department of Health Services and Population Research, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom.
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Leong OS, Ghazali S, Hussin EOD, Lam SK, Japar S, Geok SK, Azmi ISM. Depression among older adults in Malaysian daycare centres. Br J Community Nurs 2020; 25:84-90. [PMID: 32040358 DOI: 10.12968/bjcn.2020.25.2.84] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
With the older population increasing worldwide, depressive disorder in this cohort is a serious public health problem that contributes to increased healthcare costs and mortality. This study aimed to determine the prevalence of depression among older adults in Malaysia who attended a daycare centre and to identify the relationship between depression and demographic factors. A cross-sectional study was conducted with 159 older adults recruited following screening for mental capacity. The Malay Geriatric Depression Scale questionnaire was distributed among the participants to obtain descriptive data on the symptoms of depression. Some 59.1% of the participants experienced depression. The most common factors associated with depression were being divorced, low education levels and low income. The findings indicate the need to revise and re-evaluate the activities and programmes in daycare centres for older adults in order to objectively cater to their physical and emotional needs.
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Affiliation(s)
- Ong Swee Leong
- School of Nursing, Faculty of Medicine, Universiti Sultan Zainal Abidin, Terengganu, Malaysia
| | - Suriawati Ghazali
- School of Nursing, Faculty of Medicine, Universiti Sultan Zainal Abidin, Terengganu, Malaysia
| | - Emni Omar Daw Hussin
- Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Soh Kim Lam
- Department of Nursing and Rehabilitation, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Salimah Japar
- Department of Nursing and Rehabilitation, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Soh Kim Geok
- Department of Sports Studies, Faculty of Education, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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Differential Effect of Demographics, Processing Speed, and Depression on Cognitive Function in 755 Non-demented Community-dwelling Elderly Individuals. Cogn Behav Neurol 2019; 32:236-246. [DOI: 10.1097/wnn.0000000000000211] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Kall M, Marcellin F, Harding R, Lazarus JV, Carrieri P. Patient-reported outcomes to enhance person-centred HIV care. Lancet HIV 2019; 7:e59-e68. [PMID: 31776101 DOI: 10.1016/s2352-3018(19)30345-5] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/27/2019] [Accepted: 08/29/2019] [Indexed: 12/19/2022]
Abstract
Quality of life has been proposed as the fourth 90 to complement the UNAIDS 90-90-90 targets to monitor the global HIV response, highlighting a need to address the holistic needs of people living with HIV beyond viral suppression. This proposal has instigated a wider discussion about the use of patient-reported outcomes (PROs) to improve the treatment and care of an ageing HIV population with increasing comorbidities and a disproportionate burden of social problems. PROs can provide a first-hand assessment of the impact of HIV treatment and care on patients' quality of life, including symptoms. The field of PRO measures is rapidly expanding but still no gold standard exists, raising concerns about tool selection. Challenges also remain in the collection, interpretation, and use of PRO data to improve the performance of the health system. An emerging concern is how to adapt PROs to different sociocultural and geographical settings.
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Affiliation(s)
- Meaghan Kall
- HIV/STI Department, National Infection Service, Public Health England, London, UK.
| | - Fabienne Marcellin
- Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Richard Harding
- Florence Nightingale Faculty of Nursing, Midwifery, and Palliative Care, Cicely Saunders Institute, Kings College London, London, UK
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Patrizia Carrieri
- Aix Marseille University, Institut National de la Santé et de la Recherche Médicale, Institution Française Publique de Recherche, Sciences Economiques et Sociales de la Santé et Traitement de l'Information Médicale, Marseille, France; Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
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Malkin G, Hayat T, Amichai-Hamburger Y, Ben-David BM, Regev T, Nakash O. How well do older adults recognise mental illness? A literature review. Psychogeriatrics 2019; 19:491-504. [PMID: 30746830 DOI: 10.1111/psyg.12427] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 02/08/2018] [Accepted: 01/01/2019] [Indexed: 11/30/2022]
Abstract
Older adults tend to underutilise mental health services. Mental health literacy plays a critical role in identifying and overcoming barriers to accessing mental health care. The ability to recognise mental illness is an essential component of mental health literacy, with important implications to whether the person will seek professional help. We conducted a review of the literature on older adults' abilities to recognise mental illness. Of the 421 papers that were retrieved in the comprehensive search in PubMed, 32 studies met inclusion criteria. Studies were heterogeneous in terms of target population and methodology, yet findings show that older adults are less likely to correctly recognise mental disorders. Cueing older participants with mental labels improved their recognition abilities. Recognition was particularly poor among immigrant and ethnic/racial older adults, likely due to linguistic and cultural barriers. Our findings demonstrate that older adults show low levels of mental illness recognition and tend to view some illnesses as normal parts of aging. Findings emphasise the need for developing educational programs tailored by the specific phenomenology, conceptualisations and cultural meanings of mental illness among older adults, with attention to informal sources of information and social networks.
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Affiliation(s)
- Gali Malkin
- Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC) Herzliya, Herzliya, Israel
| | - Tsahi Hayat
- Sammy Ofer School of Communications, Interdisciplinary Center (IDC) Herzliya, Herzliya, Israel
| | - Yair Amichai-Hamburger
- Sammy Ofer School of Communications, Interdisciplinary Center (IDC) Herzliya, Herzliya, Israel
| | - Boaz M Ben-David
- Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC) Herzliya, Herzliya, Israel
| | - Tali Regev
- School of Economics, Interdisciplinary Center (IDC) Herzliya, Herzliya, Israel
| | - Ora Nakash
- Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC) Herzliya, Herzliya, Israel
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The effect of music therapy on reducing depression in people with dementia: A systematic review and meta-analysis. Geriatr Nurs 2019; 40:510-516. [DOI: 10.1016/j.gerinurse.2019.03.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 03/27/2019] [Accepted: 03/29/2019] [Indexed: 11/21/2022]
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Van Bortel T, Martin S, Anjara S, Nellums LB. Perceived stressors and coping mechanisms of female migrant domestic workers in Singapore. PLoS One 2019; 14:e0210717. [PMID: 30893317 PMCID: PMC6426224 DOI: 10.1371/journal.pone.0210717] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 01/01/2019] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Worldwide, there are between 50-67 million migrant domestic workers, the majority of whom are women. In many countries, provisions are not in place to protect female migrant domestic workers. These women may be at risk of occupational and social stressors, including exploitation and abuse, which may negatively impact on their quality of life, including psychological health. Research examining the occupational, social, and psychological needs of FMDWs from a public health perspective is critical to guide the development of policies which ensure wellbeing, prevent abuse, and align with international priorities to improve population health. Though there have been a number of high-profile incidents of exploitation and abuse, there has been limited research on the stressors experienced by these communities, their perceived impact, or coping mechanisms. MATERIALS AND METHODS Thematic analysis was used to analyse qualitative free-text written responses collected as part of a cross-sectional survey on the relationship between social and occupational stressors and the health and quality of life of FMDWs in Singapore. Responses correspond to open-ended questions in the qualitative component of the survey examining three domains: causes of stress, coping strategies, and what people can do to help with stress. RESULTS Responses from 182 FMDWs were analysed. Key themes were identified around causes of stress (including 'work and agency', 'the pervasiveness of financial need', and 'family and obligation'), coping strategies, and social support. Each theme describes key factors which contribute to the occupational and social stressors experienced and reported by FMDWs. DISCUSSION This research highlights the stressors FMDWs in Singapore experience, as well as key coping mechanisms. There is a clear need for policies which facilitate FMDWs' ability to utilise these coping resources, and which protect against coercive or exploitative employment conditions. Strategies are also needed to monitor and evaluate policies intended to protect FMDWs, and to strengthen the implementation of global frameworks targeted at improving workplace conditions and workers' rights.
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Affiliation(s)
- Tine Van Bortel
- Institute for Health and Human Development, University of East London, London, United Kingdom
- Cambridge Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Steven Martin
- Institute for Health and Human Development, University of East London, London, United Kingdom
| | - Sabrina Anjara
- Cambridge Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Laura B. Nellums
- Institute for Infection and Immunity, St George’s, University of London, London, United Kingdom
- Section of Infectious Diseases and Immunity, Department of Medicine, Imperial College London, London, United Kingdom
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Gordon I, Ling J, Robinson L, Hayes C, Crosland A. Talking about depression during interactions with GPs: a qualitative study exploring older people's accounts of their depression narratives. BMC FAMILY PRACTICE 2018; 19:173. [PMID: 30390637 PMCID: PMC6215358 DOI: 10.1186/s12875-018-0857-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 10/15/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Older people can struggle with revealing their depression to GPs and verbalising preferences regarding its management. This contributes to problems for GPs in both detecting and managing depression in primary care. The aim of this study was to explore older people's accounts of how they talk about depression and possible symptoms to improve communication about depression when seeing GPs. METHODS Adopting a qualitative Interpretivist methodological approach, semi-structured interviews were conducted by IG based on the principles of grounded theory and situational analysis. GPs working in north east England recruited patients aged over 65 with depression. Data analysis was carried out with a process of constant comparison, and categories were developed via open and axial coding and situational maps. There were three levels of analysis; the first developed open codes which informed the second level of analysis where the typology was developed from axial codes. The typology derived from second level analysis only is presented here as older people's views are rarely reported in isolation. RESULTS From the sixteen interviews with older people, it was evident that there were differences in how they understood and accepted their depression and that this influenced what they shared or withheld in their narratives. A typology showing three categories of older people was identified: those who appeared to talk about their depression freely yet struggled to accept aspects of it (Superficial Accepter), those who consolidated their ideas about depression aloud (Striving to Understand) and those who shared minimal detail about their depression and viewed it as part of them rather than a treatable condition (Unable to Articulate). The central finding was that older people's acceptance and understanding of their depression guided their depression narratives. CONCLUSIONS This study identified differences between older people in ways they understand, accept and share their depression. Recognising that their depression narratives can change and listening for patterns in what older people share or withhold may help GPs in facilitating communication to better understand the patient when they need to implement alternative approaches to patient management.
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Affiliation(s)
- Isabel Gordon
- Faculty of Health Sciences and Wellbeing, University of Sunderland, City Campus Chester Road, Sunderland, SR1 3SD, UK.
| | - Jonathan Ling
- Faculty of Health Sciences and Wellbeing, University of Sunderland, City Campus Chester Road, Sunderland, SR1 3SD, UK
| | - Louise Robinson
- Newcastle University Institute for Ageing and Institute for Health & Society, Newcastle University, Newcastle upon Tyne, NE4 5PL, England
| | - Catherine Hayes
- Faculty of Health Sciences and Wellbeing, University of Sunderland, City Campus Chester Road, Sunderland, SR1 3SD, UK
| | - Ann Crosland
- Faculty of Health Sciences and Wellbeing, University of Sunderland, City Campus Chester Road, Sunderland, SR1 3SD, UK
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16
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Chinekesh A, Hosseini SA, Mohammadi F, Motlagh ME, Baradaran Eftekhari M, Djalalinia S, Ardalan G. An explanatory model for the concept of mental health in Iranian youth. F1000Res 2018; 7:52. [PMID: 29560255 PMCID: PMC5832920 DOI: 10.12688/f1000research.12893.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/05/2018] [Indexed: 12/02/2022] Open
Abstract
Background: Mental health is considered as an integral and essential component of overall health. Its determinants and related factors are one of the most important research priorities, especially in adolescents and young people. Using a qualitative approach, the present study aimed to identify factors affecting the mental health of youth in Iran. Methods: In 2017, following content analysis principles, and using semi-structured in-depth interviews, we conducted a qualitative study exploring the opinions of young people about mental health. A targeted sampling method was used, and participants were young volunteers aged 18 to 30 who were selected from Tehran province, Iran. Inclusion criteria for participants was willingness to participate in the study, and ability to express their experiences. Data collection was done with individual in-depth interviews. According to the explanatory model, the interviews were directed toward the concept of mental health and path of causality and auxiliary behaviors. Results: 21 young adults participated, who met the study inclusion criteria, of whom 12 participants were male. Their mean age was 24.4 ± 0.41 years and their education varied from primary school to Master’s degree. Mental health was considered as mental well-being and a sense of satisfaction and efficacy, not only the presence of a disease or mental disorder. Based on the opinions of the interviewees, three factors of personal characteristics, family and society are involved in mental health. Individual factors were associated with behavioral and physical problems. One of the most important issues was revealed as tensions in societal and family conflicts. Economic problems and unemployment of young people were also extracted from the social factor. Conclusion: In Iran, social factors such as jobs for the unemployed and job security are considered as important determinants in the mental health of young people.
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Affiliation(s)
- Ahdieh Chinekesh
- Department of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran.,Social Determinant of Health Research Center, University of Social Welfare & Rehabilitation Sciences, Tehran, Iran
| | - Seyed Ali Hosseini
- Social Determinant of Health Research Center, University of Social Welfare & Rehabilitation Sciences, Tehran, Iran
| | - Farahnaz Mohammadi
- Social Determinant of Health Research Center, University of Social Welfare & Rehabilitation Sciences, Tehran, Iran
| | - Mohammad Esmael Motlagh
- Department of Adolescents, Youth, and School Health, Bureau of Population, Family, and School Health, Ministry of Health and Medical Education, Tehran, Iran.,Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Monir Baradaran Eftekhari
- Department of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran.,Social Determinant of Health Research Center, University of Social Welfare & Rehabilitation Sciences, Tehran, Iran
| | - Shirin Djalalinia
- Department of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran.,Non communicable Diseases Research Center, EMRI, Tehran University of Medical Sciences, Tehran, Iran
| | - Gelayol Ardalan
- Department of Adolescents, Youth, and School Health, Bureau of Population, Family, and School Health, Ministry of Health and Medical Education, Tehran, Iran
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17
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Barkham M, Moller NP, Pybis J. How should we evaluate research on counselling and the treatment of depression? A case study on how the National Institute for Health and Care Excellence's draft 2018 guideline for depression considered what counts as best evidence. COUNSELLING & PSYCHOTHERAPY RESEARCH 2017; 17:253-268. [PMID: 29151815 PMCID: PMC5678230 DOI: 10.1002/capr.12141] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background Health guidelines are developed to improve patient care by ensuring the most recent and ‘best available evidence’ is used to guide treatment recommendations. The National Institute for Health and Care Excellence's (NICE's ) guideline development methodology acknowledges that evidence needed to answer one question (treatment efficacy) may be different from evidence needed to answer another (cost‐effectiveness, treatment acceptability to patients). This review uses counselling in the treatment of depression as a case study, and interrogates the constructs of ‘best’ evidence and ‘best’ guideline methodologies. Method The review comprises six sections: (i) implications of diverse definitions of counselling in research; (ii) research findings from meta‐analyses and randomised controlled trials (RCTs); (iii) limitations to trials‐based evidence; (iv) findings from large routine outcome datasets; (v) the inclusion of qualitative research that emphasises service‐user voices; and (vi) conclusions and recommendations. Results Research from meta‐analyses and RCTs contained in the draft 2018 NICE Guideline is limited but positive in relation to the effectiveness of counselling in the treatment for depression. The weight of evidence suggests little, if any, advantage to cognitive behaviour therapy (CBT) over counselling once risk of bias and researcher allegiance are taken into account. A growing body of evidence from large NHS data sets also evidences that, for depression, counselling is as effective as CBT and cost‐effective when delivered in NHS settings. Conclusion Specifications in NICE's updated guideline procedures allow for data other than RCTs and meta‐analyses to be included. Accordingly, there is a need to include large standardised collected data sets from routine practice as well as the voice of patients via high‐quality qualitative research.
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Affiliation(s)
- Michael Barkham
- Centre for Psychological Services Research University of Sheffield Sheffield UK
| | - Naomi P Moller
- Open University Milton Keynes UK.,British Association for Counselling and Psychotherapy Lutterworth UK
| | - Joanne Pybis
- British Association for Counselling and Psychotherapy Lutterworth UK
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18
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Haroz EE, Ritchey M, Bass JK, Kohrt BA, Augustinavicius J, Michalopoulos L, Burkey MD, Bolton P. How is depression experienced around the world? A systematic review of qualitative literature. Soc Sci Med 2017; 183:151-162. [PMID: 28069271 PMCID: PMC5488686 DOI: 10.1016/j.socscimed.2016.12.030] [Citation(s) in RCA: 142] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 12/16/2016] [Accepted: 12/20/2016] [Indexed: 11/18/2022]
Abstract
To date global research on depression has used assessment tools based on research and clinical experience drawn from Western populations (i.e., in North American, European and Australian). There may be features of depression in non-Western populations which are not captured in current diagnostic criteria or measurement tools, as well as criteria for depression that are not relevant in other regions. We investigated this possibility through a systematic review of qualitative studies of depression worldwide. Nine online databases were searched for records that used qualitative methods to study depression. Initial searches were conducted between August 2012 and December 2012; an updated search was repeated in June of 2015 to include relevant literature published between December 30, 2012 and May 30, 2015. No date limits were set for inclusion of articles. A total of 16,130 records were identified and 138 met full inclusion criteria. Included studies were published between 1976 and 2015. These 138 studies represented data on 170 different study populations (some reported on multiple samples) and 77 different nationalities/ethnicities. Variation in results by geographical region, gender, and study context were examined to determine the consistency of descriptions across populations. Fisher's exact tests were used to compare frequencies of features across region, gender and context. Seven of the 15 features with the highest relative frequency form part of the DSM-5 diagnosis of Major Depressive Disorder (MDD). However, many of the other features with relatively high frequencies across the studies are associated features in the DSM, but are not prioritized as diagnostic criteria and therefore not included in standard instruments. The DSM-5 diagnostic criteria of problems with concentration and psychomotor agitation or slowing were infrequently mentioned. This research suggests that the DSM model and standard instruments currently based on the DSM may not adequately reflect the experience of depression at the worldwide or regional levels.
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Affiliation(s)
- E E Haroz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, United States.
| | - M Ritchey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 733 N Broadway, Baltimore, MD 21205, United States
| | - J K Bass
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, United States
| | - B A Kohrt
- Duke University, Duke Global Health Institute & Department of Psychiatry and Behavioral Sciences, Durham, NC 27710, United States
| | - J Augustinavicius
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, United States
| | - L Michalopoulos
- School of Social Work, Columbia University, 1255 Amsterdam Avenue, New York, NY 10027, United States
| | - M D Burkey
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, United States
| | - P Bolton
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, United States; Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, United States
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19
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Nam SI, Kim J, Shin J, Yim A. Later-Life Preparation Patterns on Depression Among Korean Baby Boom Generations. Int J Aging Hum Dev 2017; 86:172-190. [DOI: 10.1177/0091415017704950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to examine the later-life preparation pattern of Korean baby boomers and its effect on depression. Using the fourth wave of Korean Retirement and Income Study, later-life preparation was measured by economic, physical, and psychological preparation, and leisure, and family relationship satisfaction. The data analysis included latent class analysis, correlations, multiple logistic regression, and analysis of variance. Later-life patterns of Korean baby boomers were classified as high-level (35.7%), low-level (31.1%), and health and family relationship (33.2%) preparation patterns. For depression, the low-level pattern was associated with significantly higher level of depression; however, no differences were found in other two patterns. Researchers recommended a postretirement program to reflect the unique characteristics of Korean baby boomers. Moreover, findings regarding the importance of health and family relationships can be applied to other countries that have historical and cultural backgrounds similar to Korea.
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Affiliation(s)
- Seok In Nam
- School of Social Welfare, Yonsei University, Seoul, South Korea
| | - Junpyo Kim
- School of Social Welfare, Yonsei University, Seoul, South Korea
| | - Jimin Shin
- School of Social Welfare, Yonsei University, Seoul, South Korea
| | - Arram Yim
- School of Social Welfare, Yonsei University, Seoul, South Korea
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20
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Kuittinen S, Mölsä M, Punamäki RL, Tiilikainen M, Honkasalo ML. Causal attributions of mental health problems and depressive symptoms among older Somali refugees in Finland. Transcult Psychiatry 2017; 54:211-238. [PMID: 28398194 DOI: 10.1177/1363461516689003] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Causal attributions of mental health problems play a crucial role in shaping and differentiating illness experience in different sociocultural and ethnic groups. The aims of this study were (a) to analyze older Somali refugees' causal attributions of mental health problems; (b) to examine the associations between demographic and diagnostic characteristics, proxy indicators of acculturation, and causal attributions; and (c) to analyze the connections between causal attributions and the manifestation of somatic-affective and cognitive depressive symptoms. A sample of 128 Somali refugees aged 50-80 years living in Finland were asked to list the top three causes of mental health problems. Depressive symptoms were analyzed using the Beck Depression Inventory (BDI). The results showed that the most commonly endorsed causal attributions of mental health problems were jinn, jealousy related to polygamous relationships, and various life problems. We identified five attribution categories: (a) somatic, (b) interpersonal, (c) psychological, (d) life experiences, and (e) religious causes. The most common causal attribution categories were life experiences and interpersonal causes of mental health problems. Men tended to attribute mental health problems to somatic and psychological causes, and women to interpersonal and religious causes. Age and proxy indicators of acculturation were not associated with causal attributions. Participants with a psychiatric diagnosis and/or treatment history reported more somatic and psychological attributions than other participants. Finally, those who attributed mental health problems to life experiences (e.g., war) reported marginally fewer cognitive depressive symptoms (e.g., guilt) than those who did not. The results are discussed in relation to biomedical models of mental health, service use, immigration experiences, and culturally relevant patterns of symptom manifestation.
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21
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Giebel CM, Jolley D, Zubair M, Bhui KS, Challis D, Purandare N, Worden A. Adaptation of the Barts Explanatory Model Inventory to dementia understanding in South Asian ethnic minorities. Aging Ment Health 2017; 20:594-602. [PMID: 25876138 DOI: 10.1080/13607863.2015.1031637] [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: 10/23/2022]
Abstract
OBJECTIVE Studies indicate a limited understanding of dementia and its associated symptoms, causes and consequences among South Asian older adults. As a consequence, fewer people from this ethnic group receive a diagnosis of dementia. The aim of this study was to adapt the previously designed Barts Explanatory Model Inventory Checklist (BEMI-C), a tool designed to elicit perceptions of mental illness from people with different cultural backgrounds, for use with people with dementia in the South Asian population. METHOD Both a literature review and 25 qualitative interviews were conducted to find themes and perceptions that are relevant to the South Asian culture in recognising and dealing with symptoms of dementia. The emergent themes and perceptions were then added to the BEMI-C through synthesis of findings. RESULTS The initial four checklists of symptoms, causes, consequences and treatments from the BEMI-C were retained in the new BEMI-Dementia (BEMI-D) and expanded with six additional themes, including 123 new perceptions relevant to the understanding of dementia. All new themes emerged from the qualitative interviews, some of which were also found in the literature. CONCLUSION Given the national priority of improving dementia awareness and timely diagnosis, the BEMI-D can serve as a useful tool, in research and perhaps practice, to assess the barriers to dementia service uptake in this population and their understandings of dementia. Based on the detailed methodological description of the adaptation of the BEMI-C, this paper further suggests how this tool can be adapted to suit other ethnic minority groups.
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Affiliation(s)
- Clarissa M Giebel
- a Personal Social Services Research Unit , The University of Manchester , Manchester , UK
| | - David Jolley
- a Personal Social Services Research Unit , The University of Manchester , Manchester , UK
| | - Maria Zubair
- b Formerly Personal Social Services Research Unit , The University of Manchester , Manchester , UK , now School of Sociology and Social Policy , The University of Nottingham, Nottingham , UK
| | - Kamaldeep Singh Bhui
- c Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London , London , UK
| | - David Challis
- a Personal Social Services Research Unit , The University of Manchester , Manchester , UK.,d Manchester Mental Health and Social Care Trust , Manchester , UK
| | - Nitin Purandare
- d Manchester Mental Health and Social Care Trust , Manchester , UK.,e Formerly Institute of Brain, Behaviour and Mental Health , The University of Manchester , Manchester , UK
| | - Angela Worden
- a Personal Social Services Research Unit , The University of Manchester , Manchester , UK
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22
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Giebel CM, Zubair M, Jolley D, Bhui KS, Purandare N, Worden A, Challis D. South Asian older adults with memory impairment: improving assessment and access to dementia care. Int J Geriatr Psychiatry 2015; 30:345-56. [PMID: 25503751 DOI: 10.1002/gps.4242] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 11/03/2014] [Accepted: 11/03/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVE With increasing international migration, mental health care of migrants and ethnic minorities is a public health priority. South Asian older adults experience difficulties in accessing services for memory impairment, dementia and mental illness. This review examines barriers and facilitators in the pathway to culturally appropriate mental health care. METHODS Web of Knowledge, Pubmed and Ovid databases were searched for literature on South Asian older adults or their family carers, their understandings of mental illness and dementia and their pattern of service use. Dates were from 1984 to 2012. Abstracts were assessed for relevance, followed by detailed reading of salient papers. Three researchers rated the quality of each included study. A narrative synthesis was undertaken of extracted and charted data. RESULTS Eighteen studies met the eligibility criteria for the review. South Asians and health professionals highlighted several difficulties which deterred help seeking and access to care: a lack of knowledge of dementia and mental illness, and of local services; stigma; culturally preferred coping strategies; and linguistic and cultural barriers in communication and decision making. CONCLUSIONS To improve access for these groups, service users and providers need to be better informed; services need to be more culturally tailored, sometimes employing staff with similar cultural backgrounds; and health professionals can benefit from dementia education and knowledge of local services. These factors are key to the delivery of the National Dementia Strategy in England.
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Affiliation(s)
- Clarissa M Giebel
- Personal Social Services Research Unit, The University of Manchester, UK
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23
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Abstract
Limited data exist regarding community attitudes and knowledge about clinical depression in rural India. We administered 159 questionnaires and 7 focus groups to Gujarati villagers to explore knowledge and beliefs about clinical depression. Quantitative data were analyzed for frequencies, nonparametric correlations, and principal components, whereas qualitative data were coded for prominent themes. Two groups of subjects emerged from our analysis: one "medically oriented" group that viewed depression as a medical condition and expressed optimism regarding its prognosis and one "spiritually oriented" group that expressed pessimism. Correlations emerged between etiological belief, degree of optimism, and associated stigma. The subjects were pessimistic when they attributed depression to a traumatic event, punishment from God, or brain disease but optimistic when depression was attributed to socioeconomic circumstances. Overall, the subjects were knowledgeable and open-minded toward depression and demonstrated curiosity and willingness to learn more. This study will help to inform future clinical and educational outreach in rural Gujarat.
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24
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Aggarwal NK, Balaji M, Kumar S, Mohanraj R, Rahman A, Verdeli H, Araya R, Jordans MJD, Chowdhary N, Patel V. Using consumer perspectives to inform the cultural adaptation of psychological treatments for depression: a mixed methods study from South Asia. J Affect Disord 2014; 163:88-101. [PMID: 24836093 PMCID: PMC4037874 DOI: 10.1016/j.jad.2014.03.036] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 03/14/2014] [Accepted: 03/17/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Integrating consumer perspectives in developing and adapting psychological treatments (PTs) can enhance their acceptability in diverse cultural contexts. OBJECTIVE To describe the explanatory models (EMs) of depression in South Asia with the goal of informing the content of culturally appropriate PTs for this region. METHODS Two methods were used: a systematic review of published literature on the EMs of depression in South Asia; and in-depth interviews with persons with depression and family caregivers in two sites in India. Findings from both were analysed independently and then triangulated. RESULTS There were 19 studies meeting our inclusion criteria. Interviews were conducted with 27 patients and 10 caregivers. Findings were grouped under four broad categories: illness descriptions, perceived impact, causal beliefs and self-help forms of coping. Depression was characterised predominantly by somatic complaints, stress, low mood, and negative and ruminative thoughts. Patients experienced disturbances in interpersonal relationships occupational functioning, and stigma. Negative life events, particularly relationship difficulties, were perceived as the main cause. Patients mostly engaged in distracting activities, religious practices, and received support from family and friends to cope with the illness. LIMITATIONS The primary data are entirely from India but the studies from the literature review covering South Asia are consistent with these findings. This study also does not include literature in local languages or explore how consumer perspectives change over time. CONCLUSIONS EMs can inform cultural adaptations to PTs for depression in South Asia by defining target outcomes, content for psycho-education, and culturally appropriate treatment strategies.
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Affiliation(s)
- Neil Krishan Aggarwal
- Columbia University, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 11, New York, NY 10032, USA.
| | - Madhumitha Balaji
- Parivartan Trust, Plot no. 20, Vijaya Villa Survey, No. 235A, Sanjay Park, Lane no. 1, Lohgaon Airport Road, Pune 411014, India; Sangath Centre, 841/1 Alto-Porvorim, Sangath, Goa 403521, India.
| | - Shuba Kumar
- Samarth, No. 100, Warren Road, Mylapore, Chennai 600004, India.
| | - Rani Mohanraj
- Samarth, No. 100, Warren Road, Mylapore, Chennai 600004, India.
| | - Atif Rahman
- University of Liverpool, Institute of Psychology, Health & Society, Child Mental Health Unit, Alder Hey Children׳s NHS Foundation Trust, Mulberry House, Eaton Road, Liverpool L12 2AP, UK.
| | - Helena Verdeli
- Department of Counselling and Clinical Psychology, Teachers College, Columbia University, 525W 120th Street, New York City, NY 10027, USA.
| | - Ricardo Araya
- Academic Unit of Psychiatry, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK.
| | - M J D Jordans
- Health Net TPO, Lizzy Ansinghstraat 163, 1073 RG Amsterdam, The Netherlands; Center for Global Mental Health, Institute of Psychiatry, King's College London, Box P029, De Crespigny Park, London SE5 8AF, UK.
| | - Neerja Chowdhary
- Sangath Centre, 841/1 Alto-Porvorim, Sangath, Goa 403521, India.
| | - Vikram Patel
- Sangath Centre, 841/1 Alto-Porvorim, Sangath, Goa 403521, India; London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7H, UK.
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25
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Abstract
Cultural psychiatry research in the UK comprises a broad range of diverse methodologies, academic disciplines, and subject areas. Methodologies range from epidemiological to anthropological/ethnographic to health services research; mixed methods research is becoming increasingly popular, as are public health and health promotional topics. After briefly outlining the history of cultural psychiatry in the UK we will discuss contemporary research. Prominent themes include: the epidemiology of schizophrenia among Africans/Afro-Caribbeans, migration and mental health, racism and mental health, cultural identity, pathways to care, explanatory models of mental illness, cultural competence, and the subjective experiences of healthcare provision among specific ethnic groups such as Bangladeshis and Pakistanis. Another strand of research that is attracting increasing academic attention focuses upon the relationship between religion, spirituality, and mental health, in particular, the phenomenology of religious experience and its mental health ramifications, as well as recent work examining the complex links between theology and psychiatry. The paper ends by appraising the contributions of British cultural psychiatrists to the discipline of cultural psychiatry and suggesting promising areas for future research.
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Affiliation(s)
- Simon Dein
- University College London and University of Durham
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26
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Simmonds RL, Tylee A, Walters P, Rose D. Patients' perceptions of depression and coronary heart disease: a qualitative UPBEAT-UK study. BMC FAMILY PRACTICE 2013; 14:38. [PMID: 23509869 PMCID: PMC3606418 DOI: 10.1186/1471-2296-14-38] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 02/21/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND The prevalence of depression in people with coronary heart disease (CHD) is high but little is known about patients' own perceptions and experiences of this. This study aimed to explore (i) primary care (PC) patients' perceptions of links between their physical condition and mental health, (ii) their experiences of living with depression and CHD and (iii) their own self-help strategies and attitudes to current PC interventions for depression. METHOD Qualitative study using consecutive sampling, in-depth interviews and thematic analysis using a process of constant comparison. 30 participants from the UPBEAT-UK cohort study, with CHD and symptoms of depression. All participants were registered on the General Practitioner (GP) primary care, coronary register. RESULTS A personal and social story of loss underpinned participants' accounts of their lives, both before and after their experience of having CHD. This theme included two interrelated domains: interpersonal loss and loss centred upon health/control issues. Strong links were made between CHD and depression by men who felt emasculated by CHD. Weaker links were made by participants who had experienced distressing life events such as divorce and bereavement or were living with additional chronic health conditions (i.e. multimorbidity). Participants also felt 'depressed' by the 'medicalisation' of their lives, loneliness and the experience of ageing and ill health. Just under half the sample had consulted their GP about their low mood and participants were somewhat ambivalent about accessing primary care interventions for depression believing the GP would not be able to help them with complex health and social issues. Talking therapies and interventions providing the opportunity for social interaction, support and exercise, such as Cardiac Rehabilitation, were thought to be helpful whereas anti-depressants were not favoured. CONCLUSIONS The experiences and needs of patients with CHD and depression are diverse and include psycho-social issues involving interpersonal and health/control losses. In view of the varying social and health needs of patients with CHD and depression the adoption of a holistic, case management approach to care is recommended together with personalised support providing the opportunity for patients to develop and achieve life and health goals, where appropriate.
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Affiliation(s)
- Rosemary L Simmonds
- Service User Research Enterprise (SURE), Institute of Psychiatry, King’s College London, London, UK
- Health Services and Population Research Department, Institute of Psychiatry, King’s College London, De Crespigny Park, PO Box 34, London, SE5 8AF, UK
| | - Andre Tylee
- Section of Primary Care Mental Health, Institute of Psychiatry, King’s College London, London, UK
- Health Services and Population Research Department, Institute of Psychiatry, King’s College London, De Crespigny Park, PO Box 34, London, SE5 8AF, UK
| | - Paul Walters
- Section of Primary Care Mental Health, Institute of Psychiatry, King’s College London, London, UK
- Health Services and Population Research Department, Institute of Psychiatry, King’s College London, De Crespigny Park, PO Box 34, London, SE5 8AF, UK
| | - Diana Rose
- Service User Research Enterprise (SURE), Institute of Psychiatry, King’s College London, London, UK
- Health Services and Population Research Department, Institute of Psychiatry, King’s College London, De Crespigny Park, PO Box 34, London, SE5 8AF, UK
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27
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Karasz A, Patel V, Kabita M, Shimu P. "Tension" in South Asian women: developing a measure of common mental disorder using participatory methods. Prog Community Health Partnersh 2013; 7:429-41. [PMID: 24375184 PMCID: PMC4552248 DOI: 10.1353/cpr.2013.0046] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Although common mental disorder (CMD) is highly prevalent among South Asian immigrant women, they rarely seek mental treatment. This may be owing in part to the lack of conceptual synchrony between medical models of mental disorder and the social models of distress common in South Asian communities. Furthermore, common mental health screening and diagnostic measures may not adequately capture distress in this group. Community-based participatory research (CBPR) is ideally suited to help address measurement issues in CMD as well as to develop culturally appropriate treatment models. OBJECTIVES To use participatory methods to identify an appropriate, culturally specific mental health syndrome and develop an instrument to measure this syndrome. METHODS We formed a partnership between researchers, clinicians, and community members. The partnership selected a culturally specific model of emotional distress/illness, "tension," as a focus for further study. Partners developed a scale to measure Tension and tested the new scale on 162 Bangladeshi immigrant women living in the Bronx. RESULTS The 24-item "Tension Scale" had high internal consistency (α = 0.83). On bivariate analysis, the scale significantly correlated in the expected direction with depressed as measured by the Patient Health Questionnaire (PHQ-2), age, education, self-rated health, having seen a physician in the past year, and other variables. CONCLUSIONS Using participatory techniques, we created a new measure designed to assess CMD in an isolated immigrant group. The new measure shows excellent psychometric properties and will be helpful in the implementation of a community-based, culturally synchronous intervention for depression. We describe a useful strategy for the rapid development and field testing of culturally appropriate measures of mental distress and disorder.
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Sharma S, Bhui K, Chilcot J, Wellsted D, Farrington K. Identifying depression in South asian patients with end-stage renal disease: considerations for practice. NEPHRON EXTRA 2011; 1:262-71. [PMID: 22470400 PMCID: PMC3290835 DOI: 10.1159/000331446] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Depression is a prevalent burden for patients with end-stage renal disease (ESRD) and one that is under-recognized and consequently under-treated. Although several studies have explored the association between depression symptoms, treatment adherence and outcomes in Euro-American patient groups, quantitative and qualitative exploration of these issues in patients from different cultural and ethnic backgrounds has been lacking. This review discusses the methodological issues associated with measuring depression in patients of South Asian origin who have a 3- to 5-fold greater risk of developing ESRD. There is a need to advance research into the development of accurate screening practices for this patient group, with an emphasis on studies utilizing rigorous approaches to evaluating the use of both emic (culture-specific) and etic (universal or culture-general) screening instruments.
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Affiliation(s)
- Shivani Sharma
- School of Psychology, University of Hertfordshire, Hatfield, UK
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Joo JH, Wittink M, Dahlberg B. Shared conceptualizations and divergent experiences of counseling among African American and white older adults. QUALITATIVE HEALTH RESEARCH 2011; 21:1065-1074. [PMID: 21464469 PMCID: PMC6588405 DOI: 10.1177/1049732311404247] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Research findings suggest that older adults prefer counseling for depression treatment; however, few older adults use counseling services. In this article we present the results of our analysis of semistructured interviews with 102 older adults to explore conceptualizations of counseling and impediments to use among African American and White older adults. We found that older adults believe counseling is beneficial; however, use was hindered in multiple ways. Older adults were skeptical about establishing a caring relationship with a professional. African American older adults did not mention social relationships to facilitate depression care, whereas White older adults described using personal relationships to navigate counseling services. African American older men were least familiar with counseling. Our findings suggest that African American and White older adults share a strong cultural model of counseling as beneficial; however, significant impediments exist and affect older adults differentially based on ethnicity.
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Affiliation(s)
- Jin Hui Joo
- University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
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Wittink MN, Givens JL, Knott KA, Coyne JC, Barg FK. Negotiating depression treatment with older adults: primary care providers' perspectives. J Ment Health 2011; 20:429-37. [PMID: 21780938 DOI: 10.3109/09638237.2011.556164] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Primary care occupies a strategic position in the evaluation and treatment of depression in late life, yet many older patients do not initiate or adhere to treatments available in primary care. AIM To explore how primary care providers describe the process of discussing depression care with older adults. METHOD Semi-structured interviews conducted with 15 providers involved with intervention studies of depression management for older adults. We used the constant comparative method to identify themes related to negotiating the treatment of depression with older adults. RESULTS Providers felt that older patients often attribute depression to non-medical causes. They talked about the challenges and described the need to 'convince' them of the medical model of depression. CONCLUSION How primary care physicians surmise patients' views of depression may influence the discussion of depression in practice. As medication is most often provided for depression treatment, some may feel compelled to convince their patients of biomedical explanations while others may avoid treating depression altogether.
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Affiliation(s)
- Marsha N Wittink
- Department of Family Medicine and Psychiatry, School of Medicine and Dentistry, University of Rochester, Rochester, New York 14642, USA.
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Fitzsimmons S, Schoenfelder DP. Evidence-based practice guideline: wheelchair biking for the treatment of depression. J Gerontol Nurs 2011; 37:8-15. [PMID: 21717979 DOI: 10.3928/00989134-20110602-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Depression is a problem that will continue to burden older adults and challenge health care providers. Failing to recognize and effectively treat depression in institutionalized older adults is sanctioning these members of society to live their final years in despair and emotional suffering. The wheelchair biking program described in this evidence-based practice guideline provides a refreshing, safe, innovative tool to address depression and improve quality of life in older adults.
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Affiliation(s)
- Suzanne Fitzsimmons
- University of North Carolina at Greensboro, Greensboro, North Carloina, USA.
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Conner KO, Lee B, Mayers V, Robinson D, Reynolds CF, Albert S, Brown C. Attitudes and beliefs about mental health among African American older adults suffering from depression. J Aging Stud 2010; 24:266-277. [PMID: 21423819 DOI: 10.1016/j.jaging.2010.05.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Depression among older adults is a major public health concern leading to increased disability and mortality. Less than 3% of older adults utilize professional mental health services for the treatment of depression, less than any other adult age group. And despite similar rates of depression, African Americans are significantly less likely to seek, engage and be retained in professional mental health services than their white counterparts. Cultural differences in the way depression symptoms are manifested, defined, interpreted and labeled may in part explain some of these racial differences in help-seeking behaviors. Focus group methodology was utilized to identify and explore attitudes and beliefs about depression and mental health treatment utilization among 42 older African Americans who had recently suffered a major depressive episode. Thematic analysis of identified six overarching themes: (a) perceptions of depression, (b) the African American experience, (c) seeking treatment as a last resort, (d) myths about treatment, (e) stigma associated with seeking treatment and (f) culturally appropriate coping strategies. We discuss implications for practice, education and research.
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Affiliation(s)
- Kyaien O Conner
- Department of Psychiatry, School of Medicine, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213, United States
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Abstract
Standard psychiatric criteria for depression developed in the United States and United Kingdom are increasingly used worldwide to establish the prevalence of clinical disorders and to help develop services. However, these approaches are rarely sensitive to local and cultural expressions of symptoms or beliefs about treatment. Mismatch between diagnostic criteria and local understanding may result in underreporting of depression and underutilization of services. Little such research has been conducted in Malaysia, despite the acknowledged high rate of depression and low access to services. This study examines depression in Moslem Malay women living in Johor Bahru, Southern Peninsular Malaysia, to explore depression symptoms using the Structured Clinical Interview for DSM-IV. The 61 women interviewed were selected on the basis of high General Health Questionnaire scores from a large questionnaire survey of 1,002 mothers. The illustrative analysis looks at descriptions of depressed mood, self-depreciation and suicidal ideation, as well as attitudes toward service use. The women gave full and open descriptions of their emotional symptoms, easily recognizable by standard symptom categories, although somatic symptoms were commonly included, and the spiritual context to understanding depression was also prevalent. However, few women had knowledge about treatment or sought medical services, although some sought help from local spiritual healers. Attending to such views of depression can help develop services in Malaysia.
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Affiliation(s)
- Nor Ba'yah Abdul Kadir
- Faculty of Social Science and Humanities, Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia.
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Lawrence V, Samsi K, Banerjee S, Morgan C, Murray J. Threat to valued elements of life: the experience of dementia across three ethnic groups. THE GERONTOLOGIST 2010; 51:39-50. [PMID: 20724657 DOI: 10.1093/geront/gnq073] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE There is a fundamental knowledge gap regarding the experience of dementia within minority ethnic groups in the United Kingdom and elsewhere. The present study examined the subjective reality of living with dementia from the perspective of people with dementia within the 3 largest ethnic groups in the United Kingdom. DESIGN AND METHODS This was a qualitative study in which in-depth individual interviews were conducted with 11 Black Caribbean, 9 south Asian, and 10 White British older people with dementia. The lack of information in this area prompted the use of a grounded theory approach. RESULTS The main theme to emerge from the interviews with the people with dementia was "threat to valued elements of life." Participants engaged in a process of appraisal in which they assessed the degree to which their condition and support needs interfered with valued elements of life. The analysis revealed that each element of this process was culturally informed. IMPLICATIONS There is potential for modifying beliefs to reduce the perceived threat of dementia and for family and professional carers to promote the roles, relationships, and activities that each person with dementia values. The findings outlined in this paper can inform the development of a culturally sensitive approach.
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Affiliation(s)
- Vanessa Lawrence
- Institute of Psychiatry, King's College London, P026, De Crespigny Park, London SE5 8AF, UK.
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Valkila N, Litja H, Aalto L, Saari A. Consumer panel study on elderly people's wishes concerning services. Arch Gerontol Geriatr 2010; 51:e66-71. [PMID: 20047767 DOI: 10.1016/j.archger.2009.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Revised: 12/02/2009] [Accepted: 12/04/2009] [Indexed: 11/16/2022]
Abstract
This study informs on the wishes and needs of elderly people themselves regarding services for the elderly. The data for the study were gathered using a consumer panel method. Elderly people desire assistance in heavy cleaning chores, in outdoor activities and in carrying out their personal business. Elderly people felt that there should be more recreational services available. Elderly people link aging with feelings of insecurity and loneliness. Becoming a service user for the first time is felt to be a very difficult step to take, and so this decision is postponed as long as possible. The elderly people desire a service for assessing their individual service needs in an organized, expert and objective fashion. The study indicates that elderly people value the human contact gained through service provision. The consumer panel method for collecting data was successful.
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Affiliation(s)
- Noora Valkila
- Faculty of Engineering and Architecture, Department of Structural Engineering and Building Technology, Helsinki University of Technology, Box 2100, 02015 TKK, Finland
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Black HK, Rubinstein RL. The effect of suffering on generativity: accounts of elderly African American men. J Gerontol B Psychol Sci Soc Sci 2009; 64:296-303. [PMID: 19182225 DOI: 10.1093/geronb/gbn012] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND This article focuses on attitudes to and behaviors of generativity in 6 older African American (AA) men. METHODS Data on generativity emerged from in-depth qualitative research that explored experiences of suffering in community-dwelling persons aged 80 years and over. RESULTS For these AA men, experiences of racism were salient in stories of suffering, and suffering was intricately related to attitudes and behaviors of generativity. We placed men's narratives, showing the link between suffering and generativity, in 3 categories: Generativity is rooted in (a) suffering and in empathy for suffering others, (b) experiences of redemption from suffering, and (c) religious belief that assuages suffering. CONCLUSIONS These AA men's generative behaviors were shaped by unique life experiences, including experiences of suffering. Bequeathing a legacy to succeeding generations was tied to suffering experiences, to the personal and communal identities that emerged from suffering, to the importance of inter- and intragenerational community, and to what men believed others needed from them.
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Affiliation(s)
- Helen K Black
- Jefferson Center for Applied Research on Aging and Health, Thomas Jefferson University, 130 South 9th Street, Suite 515, Philadelphia, PA, USA.
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37
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Fu CM, Parahoo K. Causes of depression: perceptions among people recovering from depression. J Adv Nurs 2009; 65:101-9. [DOI: 10.1111/j.1365-2648.2008.04845.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kuo BCH, Chong V, Joseph J. Depression and its psychosocial correlates among older Asian immigrants in North America: a critical review of two decades' research. J Aging Health 2008; 20:615-52. [PMID: 18768704 DOI: 10.1177/0898264308321001] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This article critically reviews two decades of empirically based depression studies on older Asian immigrants (OAIs) in North America published in English. The Psychosocial Model of Late-Life Depression is proposed as the conceptual roadmap to help interpret the findings across studies. METHODS Using multiple bibliographic databases, this review systematically summarized and evaluated findings in 24 studies in terms of: (a) the prevalence and severity of depression; (b) demographic, psychosocial, cultural, and health risk factors of depression; and (c) methodological approaches and designs. RESULTS The results showed that depression is prevalent among OAIs and is linked to gender, recency of immigration, English proficiency, acculturation, service barriers, health status, relationship with children and family, and social support. However, considerable variability in the results, the sample sizes, and the use of measurements were also found across studies. DISCUSSION Recommendations for future research and the provision of clinical and community services are discussed within the psychosocial model.
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Affiliation(s)
- Ben C H Kuo
- Department of Psychology, University of Windsor, 401 Sunset Avenue, Chrysler Hall South 261-1, Windsor, Ontario, Canada N9B 3P4.
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Proctor EK, Hasche L, Morrow-Howell N, Shumway M, Snell G. Perceptions about competing psychosocial problems and treatment priorities among older adults with depression. PSYCHIATRIC SERVICES (WASHINGTON, D.C.) 2008. [PMID: 18511588 DOI: 10.1176/appi.ps.59.6.670] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Depression often co-occurs with other conditions that may pose competing demands to depression care, particularly in later life. This study examined older adults' perceptions of depression among co-occurring social, medical, and functional problems and compared the priority of depression with that of other problems. METHODS The study's purposeful sample comprised 49 adults age 60 or older with a history of depression and in publicly funded community long-term care. Four-part, mixed-methods interviews sought to capture participants' perceptions of life problems as well as the priority they placed on depression. Methods included standardized depression screening, semistructured qualitative interviews, listing of problems, and qualitative and quantitative analysis of problem rankings. RESULTS Most participants identified health, functional, and psychosocial problems co-occurring with depressive symptoms. Depression was ranked low among the co-occurring conditions; 6% ranked depression as the most important of their problems, whereas 45% ranked it last. Relative rank scores for problems were remarkably similar, with the notable exception of depression, which was ranked lowest of all problems. Participants did not see depression as a high priority compared with co-occurring problems, particularly psychosocial ones. CONCLUSIONS Effective and durable improvements to mental health care must be shaped by an understanding of client perceptions and priorities. Motivational interviewing, health education, and assessment of treatment priorities may be necessary in helping older adults value and accept depression care. Nonspecialty settings of care may effectively link depression treatment to other services, thereby increasing receptivity to mental health services.
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Affiliation(s)
- Enola K Proctor
- Brown School of Social Work, Washington University, 1 Brookings Dr., Campus Box 1093, St. Louis, MO 63130, USA.
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Wittink MN, Dahlberg B, Biruk C, Barg FK. How older adults combine medical and experiential notions of depression. QUALITATIVE HEALTH RESEARCH 2008; 18:1174-83. [PMID: 18689531 PMCID: PMC2782754 DOI: 10.1177/1049732308321737] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Past research has suggested that patients might not accept depression treatment in part because of differences between patient and doctor understandings of depression. In this article, we use a cultural models approach to explore how older adults incorporate clinical and experiential knowledge into their model of depression. We conducted semistructured interviews about depression with 19 patients aged 65 years and older who were identified by their physicians as depressed. We found that whereas older adults viewed as helpful the doctor's ability to identify symptoms and "put it all together" into a diagnosis, they felt that this viewpoint omitted important information about the etiology and feeling of depression grounded in embodied experience and social context. Our findings suggest that more emphasis on issues related to the etiology of depression, the effect of depression on social relationships, and emotions emanating from depression might lead to more acceptable depression treatments for older adults.
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Hunter MS, Gupta P, Papitsch-Clark A, Bhugra D, Sturdee D. Culture, country of residence and subjective well-being: a comparison of South Asian mid-aged women living in the UK, UK Caucasian women and women living in Delhi, India. ACTA ACUST UNITED AC 2008. [DOI: 10.1080/17542860802121000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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La Fontaine J, Ahuja J, Bradbury NM, Phillips S, Oyebode JR. Understanding dementia amongst people in minority ethnic and cultural groups. J Adv Nurs 2008; 60:605-14. [PMID: 18039247 DOI: 10.1111/j.1365-2648.2007.04444.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM This paper is a report of a study to explore perceptions of ageing, dementia and ageing-associated mental health difficulties amongst British people of Punjabi Indian origin. BACKGROUND People from ethnic minorities are often under-represented in mental health services. Contributing factors may include lack of knowledge of dementia in these communities, lack of detection in primary care, expectations of family care and lack of appropriate services. For this to change, greater knowledge is needed about awareness and conceptualization of dementia in minority ethnic communities. METHOD A focus-group study was conducted between 2001 and 2003 with 49 English-, Hindi- and Punjabi-speaking British South Asians, aged 17-61 years. Views of ageing and ageing-associated difficulties were explored in initial groups. In a second set of groups, vignettes were used for more specific exploration of awareness and understanding of dementia. Data were subjected to thematic analysis. FINDINGS Ageing was seen as a time of withdrawal and isolation, and problems as physical or emotional; cognitive impairment was seldom mentioned. There was an implication that symptoms of dementia partly resulted from lack of effort by the person themselves and possibly from lack of family care. Therefore people should overcome their own problems and family action might be part of the solution. There was a sense of stigma and a lack of knowledge about mental illness and services, alongside disillusionment with doctors and exclusion from services. CONCLUSION Health promotion and health interventions delivered with respect for the cultural context are needed, as well as education of healthcare professionals about South Asian conceptualizations of dementia.
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Affiliation(s)
- Jenny La Fontaine
- Birmingham and Solihull Mental Health Trust, Working Age Dementia Service, Birmingham, UK
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The development of valid subtypes for depression in primary care settings: a preliminary study using an explanatory model approach. J Nerv Ment Dis 2008; 196:289-96. [PMID: 18414123 PMCID: PMC2774710 DOI: 10.1097/nmd.0b013e31816a496e] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A persistent theme in the debate on the classification of depressive disorders is the distinction between biological and environmental depressions. Despite decades of research, there remains little consensus on how to distinguish between depressive subtypes. This preliminary study describes a method that could be useful, if implemented on a larger scale, in the development of valid subtypes of depression in primary care settings, using explanatory models of depressive illness. Seventeen depressed Hispanic patients at an inner city general practice participated in explanatory model interviews. Participants generated illness narratives, which included details about symptoms, cause, course, impact, health seeking, and anticipated outcome. Two distinct subtypes emerged from the analysis. The internal model subtype was characterized by internal attributions, specifically the notion of an "injured self." The external model subtype conceptualized depression as a reaction to life situations. Each subtype was associated with a distinct constellation of clinical features and health seeking experiences. Future directions for research using explanatory models to establish depressive subtypes are explored.
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Al-Adawi S, Dorvlo ASS, Al-Naamani A, Glenn MB, Karamouz N, Chae H, Zaidan ZAJ, Burke DT. The ineffectiveness of the Hospital Anxiety and Depression Scale for diagnosis in an Omani traumatic brain injured population. Brain Inj 2008; 21:385-93. [PMID: 17487636 DOI: 10.1080/02699050701311059] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The rehabilitation of the traumatic brain injury (TBI) patient is especially challenging in non-western populations as the phenotypic indicators as well as the neurobehavioral assessments for the survivors of brain injury are limited. OBJECTIVE The study screened for the prevalence of anxiety and depressive states among patients with TBI and examined the validity of the Hospital Anxiety and Depression Scale (HADS) to identify TBI patients with comorbid affective dysfunctions, specifically anxiety and depressive disorders, in an Omani population. METHODS Sixty-eight survivors of TBI were screened with the semi-structured, Composite International Diagnostic Interview (CIDI) and the HADS. A receiver operating characteristics (ROC) curve was calculated to discriminate the power of the HADS for every possible threshold score. RESULTS The semi-structured interview revealed the prevalence rate of 57.4% for depressive disorder and 50% for anxiety disorder. The sensitivity (53.8%) and specificity 75.9%, gave the best compromise using the cut-off score of 4, suggesting HADS is not a useful screening tool for this particular population. CONCLUSIONS Phenotypic indicators as detected by CIDI revealed that prevalence of affective dysfunctionality is common among this TBI population. Although the HADS is the most widely used screening instrument in other clinical populations, it does not appear to be a reliable resource in identifying depression and anxiety in people with traumatic brain injury in Oman.
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Affiliation(s)
- Samir Al-Adawi
- Department of Behavioral Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman.
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Black HK, White T, Hannum SM. The lived experience of depression in elderly African American women. J Gerontol B Psychol Sci Soc Sci 2007; 62:S392-8. [PMID: 18079427 PMCID: PMC4539960 DOI: 10.1093/geronb/62.6.s392] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This article focuses on the lived experience of depression in 20 elderly African American women. METHODS Data on depression emerged from research that qualitatively explored experiences of depression, sadness, and suffering in 120 community-dwelling persons aged 80 and older, stratified by gender, ethnicity, and self-reported health. RESULT We placed women's narratives under three general themes: Depression was (a) linked with diminishment of personal strength, (b) related to sadness and suffering, and (c) preventable or resolvable through personal responsibility. Brief accounts illustrate how themes emerged in women's discussion of depression. DISCUSSION African American women created a language for depression that was rooted in their personal and cultural history and presented in vivid vignettes through their life stories. Their belief systems and the language they used to describe depression are integral aspects of the lived experience of depression.
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Affiliation(s)
- Helen K Black
- Center for Applied Research on Aging and Health, Thomas Jefferson University, 130 South 9th Street, Philadelphia, PA 19107, USA.
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Murray J, Banerjee S, Byng R, Tylee A, Bhugra D, Macdonald A. Primary care professionals' perceptions of depression in older people: a qualitative study. Soc Sci Med 2006; 63:1363-73. [PMID: 16698157 DOI: 10.1016/j.socscimed.2006.03.037] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2006] [Indexed: 01/07/2023]
Abstract
An understanding of patients' perspectives is crucial to improving engagement with health care services. For older people who may not wish to bother medical professionals with problems of living such as depression, such exploration becomes critical. General practitioners (GPs), nurses and counsellors working in 18 South London primary care teams were interviewed about their perceptions of depression in older people. All three professional groups shared a predominantly psychosocial model of the causes of depression. While presentation of somatic symptoms was seen as common in all age groups, identification of depression in older patients was complicated by co-existent physical illnesses. GPs reported that older patients rarely mentioned psychological difficulties, but practice nurses felt that older people were less inhibited in talking to them about "non-medical" problems. Many older people were perceived to regard symptoms of depression as a normal consequence of ageing and not to think it appropriate to mention non-physical problems in a medical consultation. Men were thought to be particularly reluctant to disclose emotional distress and were more vulnerable to severe depression and suicide. Some GPs had mixed feelings about offering medication to address what they believed to be the consequences of loneliness and social isolation. Participants thought that many older people regard depression as a "sign of weakness" and the perceived stigma of mental illness was widely recognised as a barrier to seeking help. Cultural variations in illness beliefs, especially the attribution of symptoms, were thought to profoundly influence the help-seeking behaviour of elders from minority ethnic groups. Families were identified as the main source of both support and distress; and as such their influence could be crucial to the identification and treatment of depression in older people.
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Affiliation(s)
- Joanna Murray
- Health Services Research Department, Institute of Psychiatry, King's College, London, UK.
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