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Limenih G, MacDougall A, Wedlake M, Nouvet E. Depression and Global Mental Health in the Global South: A Critical Analysis of Policy and Discourse. INTERNATIONAL JOURNAL OF SOCIAL DETERMINANTS OF HEALTH AND HEALTH SERVICES 2024; 54:95-107. [PMID: 38105446 PMCID: PMC10955781 DOI: 10.1177/27551938231220230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 09/09/2023] [Accepted: 11/01/2023] [Indexed: 12/19/2023]
Abstract
Over the past two decades, depression has become a prominent global public health concern, especially in low- and middle-income countries (LMICs). The World Health Organization (WHO) and the Movement for Global Mental Health have developed international guidelines to improve mental health services globally, prioritizing LMICs. These efforts hold promise for advancing care and treatment for depression and other mental, neurological, and substance abuse disorders in LMICs. The intervention guides, such as the WHO's mhGAP-Intervention Guides, are evidence-based tools and guidelines to help detect, diagnose, and manage the most common mental disorders. Using the Global South as an empirical site, this article draws on Foucauldian critical discourse and document analysis methods to explore how these international intervention guides operate as part of knowledge-power processes that inscribe and materialize in the world in some forms rather than others. It is proposed that these international guidelines shape the global discourse about depression through their (re)production of biopolitical assumptions and impacts, governmentality, and "conditions of possibility." The article uses empirical data to show nuance, complexity, and multi-dimensionality where binary thinking sometimes dominates, and to make links across arguments for and against global mental health. The article concludes by identifying several resistive discourses and suggesting reconceptualizing the treatment gap for common mental disorders.
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Affiliation(s)
- Gojjam Limenih
- School of Health Studies, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Arlene MacDougall
- Department of Pyschiatry, Western University Schulich School of Medicine & Dentistry, London, ON, Canada
| | - Marnie Wedlake
- School of Health Studies, Western University, London, ON, Canada
| | - Elysee Nouvet
- School of Health Studies, Western University, London, ON, Canada
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Lateef H, Adams L, Bernard D, Jellesma F, Frempong MRK, Boahen-Boaten BB, Leach BCB, Borgstrom E, Nartey PB. Mental Health Treatment-Seeking Appraisal, Afrocentric Cultural Norms, and Mental Health Functioning: Buffering Factors of Young Black Men's Externalizing Behavior. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01771-7. [PMID: 37624539 PMCID: PMC10894312 DOI: 10.1007/s40615-023-01771-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/15/2023] [Accepted: 08/18/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Depression rates are disproportionately high among Black American Men. This disparity--compounded by low mental healthcare seeking rates and high incorrect diagnosis rates in men--could be related to masculine norms, including self-reliance, restrictive emotionality, and stoicism. Furthermore, men are more likely to engage in externalized behavior, such as aggression, to cope with mental health challenges; this pattern is influenced by cultural and environmental factors. Contrary to these detrimental factors, social relationships, belief in social networks, and collectivism have been associated with positive mental health in these populations. Similarly, an Afrocentric worldview (including concepts like Ubuntu and African self-consciousness) has been hypothesized to promote positive mental health outcomes among Black American men. However, little research exists on harnessing these factors as a means of increasing health-seeking behaviors in young Black males. AIM To elucidate the effect of region, depression, African humanism, collectivism, and help-seeking values and needs concerning aggression in young Black males. METHOD This study included Black or African American participants (n = 428) identifying as male, aged 18-25 years, who responded to a Qualtrics survey with questions on region, aggression, depression, African humanism, collectivism, and help-seeking value and need. RESULTS Hierarchical linear regression revealed that collectivism, humanness, value, and the need for seeking treatment were inversely associated with aggression (p < 0.001). DISCUSSION/CONCLUSION Highlighting the effect of cultural norms and help-seeking behaviors and the aggravating effect of depression on aggression in young Black males can help to develop aggression-mitigating interventions rooted in Afrocentric Norms.
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Affiliation(s)
- Husain Lateef
- Washington University in St. Louis, St. Louis, MO, USA.
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Maes M, Almulla AF. Research and Diagnostic Algorithmic Rules (RADAR) and RADAR Plots for the First Episode of Major Depressive Disorder: Effects of Childhood and Recent Adverse Experiences on Suicidal Behaviors, Neurocognition and Phenome Features. Brain Sci 2023; 13:brainsci13050714. [PMID: 37239186 DOI: 10.3390/brainsci13050714] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/11/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023] Open
Abstract
Recent studies have proposed valid precision models and valid Research and Diagnostic Algorithmic Rules (RADAR) for recurrent major depressive disorder (MDD). The aim of the current study was to construct precision models and RADAR scores in patients experiencing first-episode MDD and to examine whether adverse childhood experiences (ACE) and negative life events (NLE) are associated with suicidal behaviors (SB), cognitive impairment, and phenome RADAR scores. This study recruited 90 patients with major depressive disorder (MDD) in an acute phase, of whom 71 showed a first-episode MDD (FEM), and 40 controls. We constructed RADAR scores for ACE; NLE encountered in the last year; SB; and severity of depression, anxiety, chronic fatigue, and physiosomatic symptoms using the Hamilton Depression and Anxiety Rating Scales and the FibroFatigue scale. The partial least squares analysis showed that in FEM, one latent vector (labeled the phenome of FEM) could be extracted from depressive, anxiety, fatigue, physiosomatic, melancholia, and insomnia symptoms, SB, and cognitive impairments. The latter were conceptualized as a latent vector extracted from the Verbal Fluency Test, the Mini-Mental State Examination, and ratings of memory and judgement, indicating a generalized cognitive decline (G-CoDe). We found that 60.8% of the variance in the FEM phenome was explained by the cumulative effects of NLE and ACE, in particular emotional neglect and, to a lesser extent, physical abuse. In conclusion, the RADAR scores and plots constructed here should be used in research and clinical settings, rather than the binary diagnosis of MDD based on the DSM-5 or ICD.
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Affiliation(s)
- Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
- Cognitive Fitness and Technology Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
- Department of Psychiatry, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria
- Research Institute, Medical University Plovdiv, 4002 Plovdiv, Bulgaria
- Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Republic of Korea
| | - Abbas F Almulla
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
- Medical Laboratory Technology Department, College of Medical Technology, The Islamic University, Najaf 54001, Iraq
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Research and Diagnostic Algorithmic Rules (RADAR) for mood disorders, recurrence of illness, suicidal behaviours, and the patient's lifetime trajectory. Acta Neuropsychiatr 2023; 35:104-117. [PMID: 36380512 DOI: 10.1017/neu.2022.31] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The top-down Diagnostic and Statistical Manual/International Statistical Classification of Diseases categories of mood disorders are inaccurate, and their dogmatic nature precludes both deductive (as indisputable) and inductive (as top-down) remodelling of case definitions. In trials, psychiatric rating scale scores employed as outcome variables are invalid and rely on folk psychology-like narratives. Using machine learning techniques, we developed a new precision nomothetic model of mood disorders with a recurrence of illness (ROI) index, a new endophenotype class, namely Major Dysmood Disorder (MDMD), characterised by increased ROI, a more severe phenome, and more disabilities. Nonetheless, our previous studies did not compute Research and Diagnostic Algorithmic Rules (RADAR) to diagnose MDMD and score ROI, lifetime (LT), and current suicidal behaviours, as well as the phenome of mood disorders. Here, we provide rules to compute bottom-up RADAR scores for MDMD, ROI, LT and current suicidal ideation and attempts, the phenome of mood disorders, and the lifetime trajectory of mood disorder patients from a family history of mood disorders and substance abuse to adverse childhood experiences, ROI, and the phenome. We also demonstrate how to plot the 12 major scores in a single RADAR graph, which displays all features in a two-dimensional plot. These graphs allow the characteristics of a patient to be displayed as an idiomatic fingerprint, allowing one to estimate the key traits and severity of the illness at a glance. Consequently, biomarker research into mood disorders should use our RADAR scores to examine pan-omics data, which should be used to enlarge our precision models and RADAR graph.
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Tomczyk S, Heineck S, McLaren T, Peter LJ, Schomerus G, Schmidt S, Muehlan H. Yes, I can! Development and validation of the self-efficacy for self-help scale. J Affect Disord 2023; 331:279-286. [PMID: 36933667 DOI: 10.1016/j.jad.2023.03.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/09/2023] [Accepted: 03/12/2023] [Indexed: 03/20/2023]
Abstract
BACKGROUND Self-help interventions for health complaints promise alleviation, for instance, of depressive symptoms, and have become increasingly popular. However, despite constant progress regarding digitally supported self-help, real-world uptake is low and motivational processes, like task-specific self-efficacy, are rarely investigated. Therefore, this study developed and tested the Self-Efficacy for Self-Help Scale (SESH). METHODS In a randomized controlled trial of a positive psychological online intervention to foster self-help, 344 adults (mean age = 49.26 years, SD = 27.85; 61.9 % female) completed SESH at three time points (pretest, posttest, 2-week follow-up). Psychometric testing included factorial validity, reliability (internal consistency, split-half), convergent validity (via depression coping self-efficacy), discriminant validity (via depression severity, depression literacy), sensitivity to change (due to the intervention), and predictive validity (via a theory of planned behavior questionnaire on self-help). RESULTS The unidimensional scale showed excellent reliability, construct validity, and predictive validity regarding self-help (the theory of planned behavior explained 49 % of variance in self-help intentions). The analysis did not clearly support sensitivity to change, however, as SESH scores did not change in the intervention group but were lower in the control group at posttest. LIMITATIONS The study was not representative of the population, and the intervention was not previously tested. Studies with longer follow-ups and more diverse samples are needed. CONCLUSIONS This study closes a gap in current self-help research by presenting a psychometrically sound measure to capture self-efficacy for self-help that can be used in epidemiological studies as well as clinical practice.
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Affiliation(s)
- Samuel Tomczyk
- University of Greifswald, Institute of Psychology, Department Health and Prevention, Germany.
| | - Sascha Heineck
- University of Greifswald, Institute of Psychology, Department Health and Prevention, Germany
| | - Thomas McLaren
- University of Greifswald, Institute of Psychology, Department Health and Prevention, Germany
| | - Lina-Jolien Peter
- University of Leipzig Medical Center, Department of Psychiatry and Psychotherapy, Germany
| | - Georg Schomerus
- University of Leipzig Medical Center, Department of Psychiatry and Psychotherapy, Germany
| | - Silke Schmidt
- University of Greifswald, Institute of Psychology, Department Health and Prevention, Germany
| | - Holger Muehlan
- University of Greifswald, Institute of Psychology, Department Health and Prevention, Germany
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Precision Nomothetic Medicine in Depression Research: A New Depression Model, and New Endophenotype Classes and Pathway Phenotypes, and A Digital Self. J Pers Med 2022; 12:jpm12030403. [PMID: 35330403 PMCID: PMC8955533 DOI: 10.3390/jpm12030403] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 03/01/2022] [Accepted: 03/02/2022] [Indexed: 02/07/2023] Open
Abstract
Machine learning approaches, such as soft independent modeling of class analogy (SIMCA) and pathway analysis, were introduced in depression research in the 1990s (Maes et al.) to construct neuroimmune endophenotype classes. The goal of this paper is to examine the promise of precision psychiatry to use information about a depressed person’s own pan-omics, environmental, and lifestyle data, or to tailor preventative measures and medical treatments to endophenotype subgroups of depressed patients in order to achieve the best clinical outcome for each individual. Three steps are emerging in precision medicine: (1) the optimization and refining of classical models and constructing digital twins; (2) the use of precision medicine to construct endophenotype classes and pathway phenotypes, and (3) constructing a digital self of each patient. The root cause of why precision psychiatry cannot develop into true sciences is that there is no correct (cross-validated and reliable) model of clinical depression as a serious medical disorder discriminating it from a normal emotional distress response including sadness, grief and demoralization. Here, we explain how we used (un)supervised machine learning such as partial least squares path analysis, SIMCA and factor analysis to construct (a) a new precision depression model; (b) a new endophenotype class, namely major dysmood disorder (MDMD), which is a nosological class defined by severe symptoms and neuro-oxidative toxicity; and a new pathway phenotype, namely the reoccurrence of illness (ROI) index, which is a latent vector extracted from staging characteristics (number of depression and manic episodes and suicide attempts), and (c) an ideocratic profile with personalized scores based on all MDMD features.
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Norrmén-Smith IO, Gómez-Carrillo A, Choudhury S. "Mombrain and Sticky DNA": The Impacts of Neurobiological and Epigenetic Framings of Motherhood on Women's Subjectivities. FRONTIERS IN SOCIOLOGY 2021; 6:653160. [PMID: 33928142 PMCID: PMC8076589 DOI: 10.3389/fsoc.2021.653160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/16/2021] [Indexed: 05/17/2023]
Abstract
The fields of epigenetics and neuroscience have come to occupy a significant place in individual and public life in biomedicalized societies. Social scientists have argued that the primacy and popularization of the "neuro" has begun to shape how patients and other lay people experience themselves and their lifeworlds in increasingly neurological and genetic terms. Pregnant women and new mothers have become an important new target for cutting edge neuroscientific and epigenetic research, with the Internet constituting a highly active space for engagement with knowledge translations. In this paper, we analyze the reception by women in North America of translations of nascent epigenetic and neuroscientific research. We conducted three focus groups with pregnant women and new mothers. The study was informed by a prior scoping investigation of online content. Our focus group findings record how engagement with translations of epigenetic and neuroscientific research impact women's perinatal experience, wellbeing, and self-construal. Three themes emerged in our analysis: (1) A kind of brain; (2) The looping effects of biomedical narratives; (3) Imprints of past experience and the management of the future. This data reveals how mothers engage with the neurobiological style-of-thought increasingly characteristic of public health and popular science messaging around pregnancy and motherhood. Through the molecularization of pregnancy and child development, a typical passage of life becomes saturated with "susceptibility," "risk," and the imperative to preemptively make "healthy' choices." This, in turn, redefines and shapes the experience of what it is to be a "good," "healthy," or "responsible" mother/to-be.
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Affiliation(s)
- Ingrid Olivia Norrmén-Smith
- Division of Social and Transcultural Psychiatry, Department of Psychiatry, McGill University, Montréal, QC, Canada
- *Correspondence: Ingrid Olivia Norrmén-Smith
| | - Ana Gómez-Carrillo
- Division of Social and Transcultural Psychiatry, Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Suparna Choudhury
- Division of Social and Transcultural Psychiatry, Department of Psychiatry, McGill University, Montréal, QC, Canada
- Institute of Community and Family Psychiatry, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
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Lomas T. The quiet virtues of sadness: A selective theoretical and interpretative appreciation of its potential contribution to wellbeing. NEW IDEAS IN PSYCHOLOGY 2018. [DOI: 10.1016/j.newideapsych.2018.01.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Bhugra D, Sartorius N, Fiorillo A, Evans-Lacko S, Ventriglio A, Hermans MHM, Vallon P, Dales J, Racetovic G, Samochowiec J, Roca Bennemar M, Becker T, Kurimay T, Gaebel W. EPA guidance on how to improve the image of psychiatry and of the psychiatrist. Eur Psychiatry 2015; 30:423-30. [PMID: 25735809 DOI: 10.1016/j.eurpsy.2015.02.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 02/02/2015] [Accepted: 02/02/2015] [Indexed: 01/10/2023] Open
Abstract
Stigma against mental illness and the mentally ill is well known. However, stigma against psychiatrists and mental health professionals is known but not discussed widely. Public attitudes and also those of other professionals affect recruitment into psychiatry and mental health services. The reasons for this discriminatory attitude are many and often not dissimilar to those held against mentally ill individuals. In this Guidance paper we present some of the factors affecting the image of psychiatry and psychiatrists which is perceived by the public at large. We look at the portrayal of psychiatry, psychiatrists in the media and literature which may affect attitudes. We also explore potential causes and explanations and propose some strategies in dealing with negative attitudes. Reduction in negative attitudes will improve recruitment and retention in psychiatry. We recommend that national psychiatric societies and other stakeholders, including patients, their families and carers, have a major and significant role to play in dealing with stigma, discrimination and prejudice against psychiatry and psychiatrists.
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Affiliation(s)
- D Bhugra
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - N Sartorius
- Association for the Improvement of Mental Health Programmes (AMH), Geneva, Switzerland
| | - A Fiorillo
- Department of Psychiatry, University of Naples, Naples, Italy
| | - S Evans-Lacko
- Department of Health Service and Population Research, King's College, London, UK
| | - A Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - M H M Hermans
- Child and Adolescent Psychiatry, Fortuinstraat, Mechelen, Belgium
| | - P Vallon
- Swiss Society of Psychiatry and Psychotherapy, Geneva, Switzerland
| | - J Dales
- University of Leicester, Leicester, UK
| | - G Racetovic
- Centar za Mentalino Zdravlje, Prijedor, Bosnia and Herzegovina
| | - J Samochowiec
- Department of Psychiatry, Pomeranian Medical University, Poland
| | | | - T Becker
- Department of Psychiatry II,Ulm University,Bezirkskrankenhaus, Günzburg, Germany
| | - T Kurimay
- Institute of Behaviour Sciences, Semmelweis University, Budapest, Hungary
| | - W Gaebel
- Department of Psychiatry and Psychotherapy, Heinrich-Heine-University, Düsseldorf, Germany
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Braillon A. Global health challenges facing bureaucracy: democratization or revolution? Public Health 2014; 128:1134-5. [PMID: 25457802 DOI: 10.1016/j.puhe.2014.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 07/15/2014] [Accepted: 10/13/2014] [Indexed: 10/24/2022]
Affiliation(s)
- A Braillon
- Public Health, Northern Hospital, 80000 Amiens, France.
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Affiliation(s)
- Derek Summerfield
- Institute of Psychiatry, King’s College, University of London, De Crespigny Park, London, UK.
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Ball HA, Siribaddana SH, Kovas Y, Glozier N, McGuffin P, Sumathipala A, Hotopf M. Epidemiology and symptomatology of depression in Sri Lanka: a cross-sectional population-based survey in Colombo District. J Affect Disord 2010; 123:188-96. [PMID: 19762085 PMCID: PMC2946561 DOI: 10.1016/j.jad.2009.08.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Revised: 08/13/2009] [Accepted: 08/13/2009] [Indexed: 12/02/2022]
Abstract
BACKGROUND It is important to understand the nature of depression in non-Western and lower-income countries, but little such research exists. This study aimed to examine the characteristic features of depression in Sri Lanka, and to identify environmental risk factors. METHODS Depression diagnoses, symptoms and impairment were measured using the Composite International Diagnostic Interview, in a population-based sample of 6014 twins and non-twins in the Colombo region of Sri Lanka (the CoTASS sample). Socio-demographic factors and environments were assessed via questionnaires. RESULTS Lifetime-ever depression was reported in 6.6% of participants, rising to 11.2% if the functional impairment criterion was excluded. The symptom profile of depression and its socio-demographic associations were very comparable to those in Western and more economically developed countries, whether functional impairment was included in the definition or not. Standard of living was independently associated with depression, especially among men at the more deprived end of the distribution. Specific associations were found with both financial wellbeing and material characteristics of the home environment. LIMITATIONS The observational associations identified are cross-sectional, so do not necessarily imply causal links. CONCLUSIONS Aside from a lower prevalence, depression is very similar in this predominantly urban Sri Lankan sample to higher-income, Western countries, and may be under-identified due to a relatively low cultural appropriateness of the assessment of impairment. Under Sri Lanka's cultural and environmental context, certain aspects of the material environment are associated with depression among certain segments of society, perhaps because of their particular link to social status and social networks.
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Affiliation(s)
- Harriet A. Ball
- MRC Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, De Crespigny Park, London, SE5 8AF, UK,Corresponding author. Tel.: +44 207 8485415; fax: +44 207 8480866.
| | - Sisira H. Siribaddana
- Sri Lanka Twin Registry, Institute of Research and Development, Battaramulla, Sri Lanka
| | - Yulia Kovas
- MRC Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Nick Glozier
- Sydney Medical School, University of Sydney, Sydney, Australia,Department of Psychological Medicine, Institute of Psychiatry, King's College London, UK
| | - Peter McGuffin
- MRC Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Athula Sumathipala
- Sri Lanka Twin Registry, Institute of Research and Development, Battaramulla, Sri Lanka,Section of Epidemiology, Institute of Psychiatry, King's College London, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, UK
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Abstract
Contemporary Western societies are characterized by rapid social transformations, the scope and pace of which are unprecedented in comparison to previous eras. This new era is often referred to as "postmodern." Social theory suggests that such transformations influence multifarious processes related to psychiatry, including risk factors, help-seeking behavior, the clinical encounter, and clinical outcomes. I introduce and critically discuss five key themes that arise out of sociological analysis of postmodernity and that may have special relevance to psychiatry: (1) individualization; (2) social roles and self-identity; (3) the culture of expertise; (4) the transformation of intimacy; and (5) future orientation. Although extant work implicitly corroborates the importance of the identified themes as influences relevant to psychiatry, little work in psychiatry has explicitly applied these themes or investigated their impact. Further integration of these themes into research may give a fresh perspective on important issues pertinent to contemporary psychiatry.
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Affiliation(s)
- Rob Whitley
- Dartmouth Psychiatric Research Center, Lebanon, NH 03766, USA.
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Abstract
OBJECTIVE The aim of this paper is to examine the cultural roots and transmission of Western suicide and suicidal behaviour. METHOD We explored a period of antiquity (mythical Greece-61 CE) and selected accounts of 10 prominent suicides. The precipitating circumstances were tabulated and an assessment made of the most likely attendant emotions. The same process was followed for a recent period (1994-2008), from which 10 suicides were identified. The precipitating circumstances and the attendant emotions were compared. These circumstances and emotions were then compared to statements commonly encountered in clinical practice from people demonstrating suicidal behaviour. Finally, we looked for evidence that these stories (and the response models) had entered Western culture. RESULTS Precipitating circumstances, loss of a loved one, actual or imminent execution or imprisonment, other losses and public disgrace, and the negative emotions of shame, guilt, fear, anger, grief and sorrow were common to both historical periods. These circumstances and emotions are similar to those commonly expressed by people who have demonstrated suicidal behaviour. There was a clear record (literature, visual arts) of these stories forming part of our cultural heritage. CONCLUSION Models of maladaptive responses to certain adverse circumstances are part of Western culture. Suicide as a response to certain circumstances and negative emotions can be traced back more than 2000 years. Cultural change will be necessary to minimize suicide.
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Affiliation(s)
- Saxby Pridmore
- Discipline of Psychiatry, University of Tasmania, Royal Hobart Hospital, Hobart, TAS, Australia.
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Abstract
AIM This paper uses the public record to explore the relationship between reputation damage and suicide. METHOD The public record of the last 20 years was examined for examples of individuals without evidence of mental disorder who suffered actual or threatened reputation damage and suicided shortly thereafter. RESULTS Fifteen individual cases were identified; 18 additional cases, less comprehensively detailed, were mentioned in reports of The Wood Royal Commission and Operation Auxin. All cases were male. Of the 15 individual cases, the average age was 55 years, with a range of 40 to 76 years. The available details of the 18 additional cases were consistent with these findings. CONCLUSION Middle-aged males without clear evidence of mental disorder, who suffer actual or threatened reputation damage, may be at increased risk of suicide. Naming and shaming needs to be conducted with caution.
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Affiliation(s)
- Saxby Pridmore
- Discipline of Psychiatry, University of Tasmania, Hobart, TAS, Australia.
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Summerfield D, Veale D. Proposals for massive expansion of psychological therapies would be counterproductive across society. Br J Psychiatry 2008; 192:326-30. [PMID: 18450652 DOI: 10.1192/bjp.bp.107.046961] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In 2007 the UK Government announced a substantial expansion of funding for psychological therapies in England to provide better support for people with conditions such as anxiety and depression. Will these services result in the medicalisation of normal distress? Or are they simply an evidenced-based solution for a previously unmet need? In this debate Derek Summerfield and David Veale discuss the issues raised by these controversial proposals.
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Hafizi S. Depression: epidemic or pseudo-epidemic? Med Chir Trans 2006; 99:436. [PMID: 16946381 PMCID: PMC1557874 DOI: 10.1177/014107680609900909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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James FE. Depression: Epidemic or Pseudo-Epidemic? Med Chir Trans 2006; 99:220. [PMID: 16672752 PMCID: PMC1457765 DOI: 10.1177/014107680609900508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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