Paranoid symptoms and disorders among 100 Hmong refugees: a longitudinal study

The relationship between ingroup identity and Paranoid ideation among people from African and African Caribbean backgrounds

OBJECTIVES

People from ethnic minority groups experience higher rates of paranoid delusions compared with people from ethnic majority groups. Identifying with social groups has been shown to protect against mental health symptoms; however, no studies have investigated the relationship between social identification and paranoia in ethnic minority populations. Here, we investigated the association between British identification and paranoia in a sample of people from African and African Caribbean backgrounds living in the United Kingdom. We also assessed the role of potential mediating (self-esteem and locus of control) and moderating (contact with White British people) factors.

DESIGN

Cross-sectional quantitative survey design.

METHODS

We recruited 335 people from African and African Caribbean backgrounds who completed online self-report measures of identification with Great Britain, self-esteem, locus of control, positive and negative contact with White British people, and paranoia.

RESULTS

A parallel moderated mediation model indicated that British identification was associated with lower paranoia when participants experienced primarily positive contact with White British people. British identification was associated with higher paranoia when participants had primarily negative contact with White British people. Both effects were mediated by changes in locus of control, but self-esteem was not implicated in either pathway.

CONCLUSIONS

Identification with the majority culture is associated both positively and negatively with paranoid beliefs depending on the types of social interactions people experience. The findings have implications for preventative social prescribing initiatives and for understanding the causes of the high rates of psychosis in ethnic minority populations.

PRACTITIONER POINTS

People from African and African Caribbean backgrounds experience high rates of paranoia, which may stem from social causes such as lack of belonging and negative social experiences. Among people from African backgrounds living in the UK, British identification is associated with lower paranoia when people's social experiences with White British people are positive and higher paranoia when their social experiences with White British people are negative. It is recommended that social interventions designed to reduce paranoia in vulnerable groups foster positive social contact and community belonging, which should enhance feelings of personal control. Understanding the complex interplay between social identity and social contact in the development of paranoia may help therapists and researchers better understand the phenomenology and risk factors of paranoid symptomology.

Neuropsychological research in delusional disorder: a comprehensive review

In recent decades, there has been a growing interest in the field of delusions, and different aspects of delusional disorder (DD) have been investigated. However, DD is still one of the most underresearched psychiatric disorders. In this paper, we review the literature on DD and most of the theoretical approaches proposed to explain the development and maintenance of delusions. DD research is infrequent, and delusions in this disorder have been scarcely investigated. We aim to establish the state of the art of delusions research to date and point to the shortage of neuropsychological studies in patients with DD. We also justify the need for future research into the neuropsychological correlates of DD as measured in patients with this disorder given that most previous research has mainly focused on other psychotic conditions.

A personal journey into cultural psychiatry

The two primary audiences for this article are psychiatrists interested in a cultural psychiatry career and academic as well as healthcare leaders who are in a position to support cultural psychiatry training. In addition to describing my own personal journey through cultural psychiatry, this report includes strategic recommendations for becoming a cultural psychiatrist as well as rationales for supporting a cadre of cultural psychiatrists in the coming decades. A World Health Organization (WHO) sponsored program for training clinicians in addictions is described. Finally, the account summarizes those clinical, research, educational, consultative, and leadership roles that cultural training influenced during my career.

Paranoia

Both psychology and psychiatry are dominated by individualistic accounts of paranoia (and, indeed, other forms of distress). As a corrective to these, this paper provides a social account of paranoia grounded in a minimal notion of embodied subjectivity constituted from the interpenetration of feelings, perception and discourse. Paranoia is conceptualized as a mode or tendency within embodied subjectivity, co-constituted in the dialectical associations between subjectivity and relational, social and material influences. Relevant psychiatric and psychological literature is briefly reviewed; relational, social structural and material influences upon paranoia are described; and some implications of this account for research and intervention are highlighted.

Trauma and coping in Somali and Oromo refugee youth

PURPOSE

To describe war-related trauma history, immigration factors, problems, and coping of Somali and Oromo refugee youth.

METHODS

Analysis of a subset of participants (N = 338) aged 18-25 years from a population-based survey of Somali and Oromo refugees conducted in 2000-2002. Data included trauma history, life situation, and scales for physical (Cronbach alpha =.69), psychological (alpha =.56), and social problems (alpha =.69). Data were analyzed using Chi-square and Mann-Whitney U tests.

RESULTS

Average emigration age was 14.8 years, with 4.2 years in transit and 2.0 years in the United States; 60% reported plans to return home to live. Two-thirds (66%) had less than a high school education, 49% had English language problems, 49% were employed (38% female vs. 57% male); 70% were single, with Somali females more likely than Oromo to be partnered and mothers (39% vs. 19%). There were significant ethnicity/gender differences for all problem scales. More females reported feeling alone (24% vs. 61%, p <.001). Youth with symptoms of posttraumatic stress syndrome reported more traumatic events (mean number of events: 28 vs.16). Trauma history was strongly associated with physical, psychological, and social problems. Most frequent strategies to combat sadness were praying (55.3%), sleeping (39.9%), reading (32.3%), and talking to friends (27.8%).

CONCLUSIONS

Many young Somali and Oromo immigrants to the United States experience life problems associated with war trauma and torture, but many others are coping well. The findings suggest a need to develop age-appropriate strategies to promote the health of refugee youth to facilitate their successful adaptation to adult life in the United States.

Mental disorder among refugees and the impact of persecution and exile: some findings from an out-patient population

BACKGROUND

Refugees have long been considered at risk for mental disorder. We sought to characterise this risk in an out-patient refugee sample by analysing the relationship between psychiatric symptoms and dysfunction, and between symptoms and the socio-demographic background and stressors specific to this refugee sample.

METHOD

A consecutive sample of 231 refugee patients referred to the psychiatric out-patient unit at the Psychosocial Centre for Refugees, University of Oslo, was examined with a semi-structured interview guide, Brief Psychiatric Rating Scale (BPRS), Hopkins Symptom Check-List (HSCL-25) and a check-list for post-traumatic symptoms (PTSS-10). Global Assessment of Function (GAF) scores were obtained; and the data were analysed using nine predictor variables.

RESULTS

It was found that 46.6% of the patients had a post-traumatic stress disorder according to the criteria for DSM-III-R as the main diagnosis, while the mean GAF score for the patients was 57.3. Analysis of the GAF and BPRS data did not reveal any predictor of psychotic behaviour. However, torture emerged as an important predictor of emotional withdrawal/retardation. Also, age, gender and no employment or education predicted for anxiety/depression, while refugee status and no employment or school predicted for hostility/aggression.

CONCLUSIONS

The results confirm earlier findings that refugees constitute a population at risk for mental disorder. Past traumatic stressors and current existence in exile constitute independent risk factors. However, stressors other than those discussed here appear to be important also, particularly with regard to psychotic symptoms.

Psychiatric morbidity among foreign housemaids in Kuwait

First admission rates to the psychiatric hospital in Kuwait revealed that foreign housemaids as a whole had about five times the rate of Kuwaiti females. According to hospital diagnoses the housemaids had significantly more acute situational disturbances and mania, and less depressive illness and organic mental disorders. Regarding schizophrenia and paranoid state there was no significant difference between the two groups. It is recommended that good interpreters should be appointed as part of an appropriate staffing of the psychiatric hospital.