British Gujarati Indian immigrants' and British Caucasians' beliefs about health and illness

Cross-cultural differences in depression between White British and South Asians: Causal attributions, stigma by association, discriminatory potential

OBJECTIVES

Numerous facets of public and internalized mental illness stigma have been established. This study focuses on the stigma of being associated with someone with depression and cultural differences between a Western and an Eastern culture. The aim was to compare White British and South Asians living in the United Kingdom regarding their causal explanations for depression, stigma towards people with depression and stigma by association.

DESIGN

A cross-sectional design.

METHODS

White British and South Asians (N = 137) in the United Kingdom completed a survey measuring attributions about the aetiology of depression, discriminatory potential towards people with depression and stigma by association.

RESULTS

Results revealed that South Asians attributed greater supernatural, moral and psychosocial causes to depression, while White British endorsed greater biological beliefs. South Asians reported a greater discriminatory potential towards people with depression (lower willingness for closeness, greater desire for social distance) than White British. They also indicated greater affective, cognitive and behavioural stigma by association. Stigma by association mediated the relationship between cultural group and willingness for closeness as well as desire for social distance. Perceived dangerousness was a mediator for willingness for closeness.

CONCLUSIONS

These findings suggest that a greater consideration of the role of culture in the understanding of mental health is important to combat stigma towards individuals with depression and those close to them across Western and Eastern cultures.

Worry much? Preventive health behaviours related to worry across countries amid COVID-19

This study examined the relationship between worry and health behaviours using an online survey of 69,033 respondents from 32 countries. We hypothesized that past health behaviours predicted worry experienced, which in turn predicted future health behaviours, and included a metric of cultural distance from the US. Past behaviours such as maintaining physical distance predicted higher worry, whereas worry reduced the likelihood of going outside. Being culturally dissimilar to the US was associated with lower worry. However, cultural distance was not associated with future health behaviours. We analyse worry as an approach-avoidance motivator of health behaviours from a cross-cultural perspective, to facilitate effective health communication strategies.

Cultural Differences in Psychosis: The Role of Causal Beliefs and Stigma in White British and South Asians

While previous research has demonstrated the negative impact of stigma in individuals with mental health problems, little is known about cross-cultural differences in experiences and explanations of mental health, in particular in young people, despite the first episode of psychosis often occurring in adolescence. Aim of this study was to examine cultural differences in causal beliefs and stigma toward mental health, in particular psychosis. White British and South Asian young people ( N = 128) from two schools and colleges in the United Kingdom, aged 16 to 20 years, completed a cross-sectional survey. Results revealed significant associations between ethnic group and our dependent measures. White British reported more previous contact with a mental health service as well as with people with mental health problems than South Asians. They also reported lower stigma in form of a greater intentions to engage in contact with people with mental health problems. Furthermore, South Asians reported higher beliefs in supernatural causes of psychosis than White British. Psychotic experiences moderated the effect of ethnic group on supernatural beliefs, with South Asians reporting higher supernatural beliefs than White British when their own psychotic experiences were low to moderate. We discuss the implications of the findings, arguing that a greater culture-sensitive understanding of mental health is important to reach ethnic minorities with psychosis, and to challenge stigma toward psychosis from an early age on.

The Singaporean public beliefs about the causes of mental illness: results from a multi-ethnic population-based study

AIMS

To identify the common causal beliefs of mental illness in a multi-ethnic Southeast Asian community and describe the sociodemographic associations to said beliefs. The factor structure to the causal beliefs scale is explored. The causal beliefs relating to five different mental illnesses (alcohol abuse, depression, obsessive-compulsive disorder (OCD), dementia and schizophrenia) and desire for social distance are also investigated.

METHODS

Data from 3006 participants from a nationwide vignette-based study on mental health literacy were analysed using factor analysis and multiple logistic regression to address the aims. Participants answered questions related to sociodemographic information, causal beliefs of mental illness and their desire for social distance towards those with mental illness.

RESULTS

Physical causes, psychosocial causes and personality causes were endorsed by the sample. Sociodemographic differences including ethnic, gender and age differences in causal beliefs were found in the sample. Differences in causal beliefs were shown across different mental illness vignettes though psychosocial causes was the most highly attributed cause across vignettes (endorsed by 97.9% of respondents), followed by personality causes (83.5%) and last, physical causes (37%). Physical causes were more likely to be endorsed for OCD, depression and schizophrenia. Psychosocial causes were less often endorsed for OCD. Personality causes were less endorsed for dementia but more associated with depression.

CONCLUSIONS

The factor structure of the causal beliefs scale is not entirely the same as that found in previous research. Further research on the causal beliefs endorsed by Southeast Asian communities should be conducted to investigate other potential causes such as biogenetic factors and spiritual/supernatural causes. Mental health awareness campaigns should address causes of mental illness as a topic. Lay beliefs in the different causes must be acknowledged and it would be beneficial for the public to be informed of the causes of some of the most common mental illnesses in order to encourage help-seeking and treatment compliance.

Becoming a patient-illness representations of depression of Anglo-Australian and Sri Lankan patients through the lens of Leventhal's illness representational model

BACKGROUND

Depression is prevalent globally. While the uptake of mental health services is poor in the general community, the lack of service engagement is particularly profound in migrant and refugee communities. To understand why there is under-utilisation cross-cultural comparisons of how people make sense of mental illnesses such as depression are essential.

AIMS

To verify how differing cultural aetiologies about depression influence mental health service use, this study investigated illness representational models of depression held by Sri Lankan migrants and Anglo-Australians living with depression.

METHODS

In-depth interviews ( n = 48) were conducted with Sri Lankan migrants and Anglo-Australians living with depression to explore their illness beliefs. Data were analysed using Leventhal's illness representational model.

RESULTS

Significant overlaps in illness representational models were noted but distinctive differences were found between causal and chronicity beliefs; Sri Lankan migrants more frequently endorsed depression as a time-limited condition underpinned by situational factors, whereas Anglo-Australians endorsed a chronic, biopsychosocial model of depression.

DISCUSSION AND CONCLUSION

Findings highlight the importance of forging a shared understanding of patient beliefs in the clinical encounter to ensure that interventions are coherent with illness beliefs or at least work towards improving mental health literacy. Differences in illness beliefs also provide insights into possible interventions. For example, psychosocial interventions that align with their illness beliefs may be more suited to Sri Lankan migrants than pharmaceutical or psychological ones.

Gender differences in beliefs about health: a comparative qualitative study with Ghanaian and Indian migrants living in the United Kingdom

BACKGROUND

There is a well-established association between migration to high income countries and health status, with some groups reporting poorer health outcomes than the host population. However, processes that influence health behaviours and health outcomes across minority ethnic groups are complex and in addition, culture ascribes specific gender roles for men and women, which can further influence perspectives of health. The aim of this study was to undertake a comparative exploration of beliefs of health among male and female Ghanaian and Indian migrants and White British participants residing in an urban area within the UK.

METHODS

Thirty-six participants (12 each Ghanaian, Indian and White British) were recruited through community settings and participated in a semi-structured interview focusing on participant's daily life in the UK, perceptions of their own health and how they maintained their health. Interviews were analyzed using a Framework approach.

RESULTS

Three super ordinate themes were identified and labelled (a) beliefs about health; (b) symptom interpretation and (c) self-management and help seeking. Gender differences in beliefs and health behaviour practices were apparent across participants.

CONCLUSIONS

This is the first study to undertake a comparative exploration of health beliefs among people who have migrated to the UK from Ghana and India and to compare with a local (White British) population. The results highlight a need to consider both cultural and gender-based diversity in guiding health behaviours, and such information will be useful in the development of interventions to support health outcomes among migrant populations.

The Relationship Between Culture, Health Conceptions, and Health Practices

This study investigated cultural variations in health conceptions and practices using a quasi-experimental design. A total of 60 participants, recruited from three cultural groups in Canada, were individually interviewed between the fall of 2009 and the fall of 2010. Transcribed interviews were quantified according to the importance participants ascribed to emergent themes. The data generated three intriguing findings: (a) Consistent with an interdependent self-construal or ecological self, First Nations participants were more likely to report health conceptions and practices that expand beyond the individual self to include their family, the community, and the environment when compared with Anglophones and Francophones of European ancestry; (b) First Nations participants placed more importance on maintaining their traditions and culture as a health-promoting strategy, compared with Anglophones and Francophones; and (c) some of the health conceptions identified by all three groups significantly predicted the practices they engage in to promote health. These findings suggest that culture has a noticeable impact on health conceptions, which in turn influence health practices. There are at least two important implications: (a) Health policy makers need to take into account the role culture plays in the way people conceptualize health to ensure that health policies and programs reflect the particular beliefs and needs of their target populations and (b) health-care professionals need to be aware of the diverse views of their patients to provide culturally appropriate care.

Health Beliefs regarding Dietary Behavior and Physical Activity of Surinamese Immigrants of Indian Descent in The Netherlands: A Qualitative Study

This study explored the health beliefs about eating habits and physical activity (PA) of Surinamese immigrants of Indian (Hindustani) descent to examine how health education messages to prevent obesity can be made more culturally sensitive. Indians are known for their increasing obesity incidence and are highly vulnerable for obesity-related consequences such as cardiovascular diseases and diabetes. Therefore they might benefit from culturally sensitive health education messages that stimulate healthy eating habits and increase PA levels. In order to examine how health education messages aimed at preventing obesity could be adapted to Indian culture, we interviewed eight Hindustanis living in The Netherland, and conducted two focus groups (n = 19) with members from a Surinamese Hindustani community. Results showed cultural implications that might affect the effectiveness of health education messages: karma has a role in explaining the onset of illness, traditional eating habits are perceived as difficult to change, and PA was generally disliked. We conclude that health education messages aimed at Hindustani immigrants should recognize the role of karma in explaining the onset of illness, include more healthy alternatives for traditional foods, pay attention to the symbolic meaning of food, and suggest more enjoyable and culturally sensitive forms of PA for women.

The beliefs and knowledge of patients newly diagnosed with cancer in a UK ethnically diverse population

AIMS

To compare knowledge about the outcome of cancer treatment and beliefs about the causes of cancer among British South Asian (BSA) cancer patients of predominantly Gujarati origin with the beliefs held by British White (BW) cancer patients. We also wanted to determine if these beliefs impacted upon the patients' mental health.

MATERIALS AND METHODS

We administered a questionnaire about cancer beliefs to 94 BSA and 185 BW newly diagnosed cancer patients at the Leicestershire Cancer Centre. Using a Likert seven-item scale, we analysed patients' views on confidentiality, outcome and cancer treatment and 15 items about beliefs about the causes of cancer. Patients also completed the Hospital Anxiety and Depression Scale, Patient Health Questionnaire, Mini-MAC, Distress Thermometer and newly developed Cancer Insight and Denial, and Physician/Patient Trust questionnaires.

RESULTS

Most (232/279; 83.2%) believed cancer was curable. However, significantly more BSA (10.6% versus 2.7% BW P=0.001) believed cancer was incurable. Although most (86.4%) agreed that smoking can cause cancer, there was a widespread lack of knowledge of the importance of diet and obesity as contributing causes of cancer. There was, in general, an over-emphasis on pollution, stress and injury as important aetiological agents. There was a strong belief in supernatural involvement in the development of cancer among a minority of BSA patients. Twenty per cent of this sample believed that treatment, especially surgery, caused the cancer to spread and this was associated with significant depression in BSAs (P=0.019) and anxiety in both BW (P=0.006) and BSA (P=0.0134) patients.

CONCLUSION

Our results show that there is a continual need for education about the causes of cancer both in BW and BSA patients.

Factors influencing attitudes towards seeking professional help among East and Southeast Asian immigrant and refugee women

BACKGROUND AND AIMS

It has been recognized that Asian immigrants in North America have lower rates of mental health service utilization. From the perspective of cross-cultural psychiatry, one of the most important cultural factors may be differences in the explanatory model of illness. This article examines the relationship of causal beliefs, perceived service accessibility and attitudes towards seeking mental health care.

METHOD

The sample consisted of 1000 immigrant and refugee women from five ethnic minority communities in Toronto, including three Chinese Canadian communities (Hong Kong, mainland China and Taiwan), Korean Canadians and Vietnamese Canadians. Data were acquired by a self-administered structured questionnaire. Quantitative data were analysed using MANOVA, ANOVA and stepwise multiple regression.

RESULTS

The five ethnic minority groups of women differed in their explanatory models about mental illness and distress. In the full model where other variables were controlled for, the most significant factor predicting attitudes towards seeking professional help was perceived access for all groups except the Hong Kong Chinese. In the last group, those subscribing more to a Western stress model of illness had a more positive attitude towards seeking professional help, while those subscribing more to supernatural beliefs had a more negative attitude. Age and education were not significant predictors.

CONCLUSION

Perceived access is one of the main factors that influence attitudes toward seeking professional help. Explanatory models may predict help-seeking behaviours if perceived access to such services is available.

Stigma towards people with mental illness in developing countries in Asia

BACKGROUND

There is a wide range of literature on stigmatization and discrimination of people with mental illness. Most studies, however, derive from Western countries. This review aims at summarizing results from developing countries in Asia published between 1996-2006.

METHOD

Medline search focusing on English-speaking literature.

RESULTS

Comparable to Western countries, there is a widespread tendency to stigmatize and discriminate people with mental illness in Asia. People with mental illness are considered as dangerous and aggressive which in turn increases the social distance. The role of supernatural, religious and magical approaches to mental illness is prevailing. The pathway to care is often shaped by scepticism towards mental health services and the treatments offered. Stigma experienced from family members is pervasive. Moreover, social disapproval and devaluation of families with mentally ill individuals are an important concern. This holds true particularly with regards to marriage, marital separation and divorce. Psychic symptoms, unlike somatic symptoms, are construed as socially disadvantageous. Thus, somatisation of psychiatric disorders is widespread in Asia. The most urgent problem of mental health care in Asia is the lack of personal and financial resources. Thus, mental health professionals are mostly located in urban areas. This increases the barriers to seek help and contributes to the stigmatization of the mentally ill. The attitude of mental health professionals towards people with mental illness is often stigmatizing.

CONCLUSION

This review revealed that the stigmatization of people with mental illness is widespread in Asia. The features of stigmatization-beliefs about causes of and attitudes towards mental illness, consequences for help-seeking-have more commonalities than differences to Western countries.