'Self-harm is wrong': the experience of self-harming behaviours that inflict external injuries to the body in UK-based Bangladeshi, Indian and Pakistani women: an Interpretative Phenomenological Analysis

This study investigated the experience of self-harming behaviour that inflicts external injuries to the body in UK based Indian, Pakistani, and Bangladeshi (UKBIP) women. A total of eight participants were recruited via purposive sampling and semi-structured interviews were carried out. The interviews were analysed using Interpretative Phenomenological Analysis (IPA). Analyses were carried out on an individual and group level and three super-ordinate themes, and nine sub-ordinate themes emerged. The superordinate themes were: 'Powerlessness' ('Entrapment', 'Internalised Negativity' and 'Abused by my Environment'), 'Mitigation' ('Releasing my Overwhelming Emotions', 'Connecting to my Pain' and 'Addicted to Self-harm') and 'Self-harm is Wrong' ('It must be Hidden', 'What have I done to myself?' & 'My Self-harm is Sinful'). The analyses revealed novel insights on the impact and importance of some South-Asian cultural values and beliefs on the experience of self-harm in South-Asian women. This paper will focus on the third superordinate theme and related sub themes, that of 'Self-harm is Wrong'.

Exploring mental well-being, the emotional impact of visual impairment and experiences of prejudice and discrimination among adults from minority ethnic communities in the UK

Background

Visual impairment (V.I.) has been associated with a negative impact on mental health outcomes, including a process of grief among those who lose their sight. Older adults with V.I. who had experienced discrimination have been found to be at increased risk of depression, loneliness, poorer life satisfaction and poorer quality of life. Adults from minority ethnic communities (MEC) may be at increased risk of V.I. and yet, research on the experiences of MEC adults with V.I. remains limited. This article forms part of a series which explores issues and status among MEC adults living with V.I. in the UK.

Methods

A secondary analysis of V.I. Lives survey data was performed to explore mental well-being assessed by the short Warwick-Edinburgh Mental Well-being scale (SWEMWBS), the emotional impact of V.I., and prejudice and discrimination among a matched control sample of 77 MEC and 77 adults from white communities (WC). Participants were matched by age, gender, UK region and urban/rural setting. Subgroup analyses were also conducted for the two largest MEC subgroups, Asian (n = 46) and black participants (n = 22).

Results

There were few statistically significant differences between the groups. MEC participants were significantly more likely than WC participants to rate emotional support to come to terms with their V.I. as important and to feel optimistic about their V.I. but they were significantly less likely to agree that they were receiving the level of emotional support they needed to get on with their life. Within the MEC group, participants from Asian communities had significantly poorer mental well-being, and they were also significantly more likely to agree that the general public were often prejudiced against people with V.I. and less likely to feel optimistic about their V.I. than black participants.

Conclusion

Although there were few statistically significant differences, participants from Asian communities were more likely to report poor mental and emotional well-being, and experiences of discrimination, than black and white participants. In contrast, participants from black communities fared the same as, or in some cases better than, white participants. Future research will need to confirm these findings and explore reasons for these.

Double stigma in mental health service use: Experience from ethnic minorities in Hong Kong

BACKGROUND

Ethnic minorities (EMs) typically underutilise mental health services (EMs) with issues that are not shared by the local population. Understanding the underlying perceived factors could help reduce their mental health disparities.

AIMS

This is a qualitative study aiming to examine the barriers that prevent EMs from seeking mental health services in Hong Kong.

METHODS

Six semistructured focus groups with 31 EMs who resided in Hong Kong were conducted from May 31 to June 26, 2021. The outcome measures were the themes and subthemes of perspectives on mental health service use.

RESULTS

Among 31 adults (20 [64.5%] women, 11 [35.5%] men; 17 [54.8%] aged 25-39 years) who participated, most participants self-identified as Indian (13 [41.95]) or Pakistani (10 [32.3]). There were 16 individuals (51.6%) who reported severe or higher levels of anxiety or depressive symptoms, while 12 individuals (38.7%) reported moderate levels. Three emerging themes identified for the barriers to help-seeking for psychiatric intervention were (1) preexisting problems, (2) psychaitric service lacks cultural sensitivity and (3) personal or family limitation, while that for the recommendations to improve help-seeking had six themes: (1) improve cultural sensitivity, (2) make EM mental health practitioners available, (3) improve professional conduct, (4) improve on-site support, (5) improve financial support and (6) improve mental health promotion in schools.

CONCLUSION

This study found that EMs in Hong Kong experience double stigma, which keeps them away from seeking professional mental health care. There were also disparities in the use of mental health services by ethnicity. The study also made recommendations for promoting EM help-seeking at the individual, governmental and community levels.

Effects of a culturally adapted counselling service for low-income ethnic minorities experiencing mental distress: a pragmatic randomised clinical trial

BACKGROUND

Culturally competent early mental health interventions for ethnic minorities (EMs) with no formal diagnoses are needed.

OBJECTIVES

To determine whether 8-12 weeks culturally adapted counselling (CAC) is better than waiting (waitlist (WL) group) to reduce depressive and anxiety symptoms and stress levels among EMs with elevated mental distress.

METHODS

Hong Kong EMs with mild and above-mild mental distress were randomly assigned to CAC or WL in this pragmatic, randomised, WL-controlled trial. The CAC group received the intervention after randomisation and the WL group received the intervention after 8-12 weeks (T1). The prespecified primary outcomes were depressive and anxiety symptoms and stress levels measured by the Depression, Anxiety and Stress subscales of the Depression, Anxiety and Stress Scale (DASS-D, DASS-A and DASS-S, respectively) at postintervention (T1, 8-12 weeks).

FINDINGS

A total of 120 participants were randomly assigned to either CAC (n=60) or WL (n=60), of whom 110 provided primary outcome data. At T1, CAC led to significantly lower depressive and anxiety symptom severity and stress levels compared with waiting, with unstandardised regression coefficients of -8.91 DASS-D points (95% CI -12.57 to -5.25; d=-0.90),-6.33 DASS-A points (95% CI -9.81 to -2.86; d=-0.68) and -8.60 DASS-S points (95% CI -12.14 to -5.06; d=-0.90).

CONCLUSIONS

CAC clinically outperformed WL for mild and above-mild levels of mental distress in EMs.

CLINICAL IMPLICATIONS

Making CAC routinely available for EMs in community settings can reduce healthcare burden.

TRIAL REGISTRATION NUMBER

NCT04811170.

Impacts of English language proficiency on healthcare access, use, and outcomes among immigrants: a qualitative study

BACKGROUND

Immigrants from culturally, ethnically, and linguistically diverse countries face many challenges during the resettlement phase, which influence their access to healthcare services and health outcomes. The "Healthy Immigrant Effect" or the health advantage that immigrants arrive with is observed to deteriorate with increased length of stay in the host country.

METHODS

An exploratory qualitative design, following a community-based research approach, was employed. The research team consisted of health researchers, clinicians, and community members. The objective was to explore the barriers to healthcare access among immigrants with limited English language proficiency. Three focus groups were carried out with 29 women and nine men attending English language classes at a settlement agency in a mid-sized city. Additionally, 17 individual interviews were carried out with healthcare providers and administrative staff caring for immigrants and refugees.

RESULTS

A thematic analysis was carried out with transcribed focus groups and healthcare provider interview data. Both the healthcare providers and immigrants indicated that limited language proficiency often delayed access to available healthcare services and interfered with the development of a therapeutic relationship between the client and the healthcare provider. Language barriers also impeded effective communication between healthcare providers and clients, leading to suboptimal care and dissatisfaction with the care received. Language barriers interfered with treatment adherence and the use of preventative and screening services, further delaying access to timely care, causing poor chronic disease management, and ultimately resulting in poor health outcomes. Involving untrained interpreters, family members, or others from the ethnic community was problematic due to misinterpretation and confidentiality issues.

CONCLUSIONS

The study emphasises the need to provide language assistance during medical consultations to address language barriers among immigrants. The development of guidelines for recruitment, training, and effective engagement of language interpreters during medical consultation is recommended to ensure high quality, equitable and client-centered care.

Accessing Mental Health Services: a Systematic Review and Meta-ethnography of the Experiences of South Asian Service Users in the UK

Background

Despite calls to address ethnic inequalities to accessing mental health services in the UK, governmental initiatives have had limited impact. Studies indicate that South Asian communities underutilise mental health services. Previous reviews have identified cultural and institutional factors that may influence service use, but these are mostly narrative and limited in their scope.

Method

A systematic literature search resulted in fifteen studies exploring the experiences of seeking help and barriers to accessing and using services from the perspective of British South Asian service users.

Findings

Qualitative data was synthesised through meta-ethnography, and three themes emerged: Distanced from Services, Dilemma of Trust and Threat to Cultural Identity. South Asian service users were positioned at a distance from being able to access services and stuck in a dilemma of mistrusting White and Asian professionals. They constructed their cultural identity through a set of important values which were neglected by mental health services. Service users, therefore, appeared to engage in an ongoing evaluation of the potential benefits of accessing services against the risks of threat to their personal and cultural identities. The findings are discussed in relation to Eurocentric models of care and community engagement approaches.

Conclusion

The review argues that institutional racism and cultural dissonance marginalise South Asian service users from access to quality and effective mental healthcare. It is recommended that services acknowledge the impact of alienation and powerlessness and advance their practices to establish trust and cultural safety for South Asian service users in the UK.

Young Muslim Pakistani Women's Lived Experiences of Izzat, Mental Health, and Well-Being

This article explores how six Pakistani Muslim women interpret cultural concepts of izzat (honor and self-respect); what role, if any, it has in their lives; and whether there is interplay between upholding izzat and the participants' help-seeking strategies for mental health and well-being. Semistructured interviews were conducted and analyzed with an interpretative phenomenological analytic framework. Three themes were identified: (a) "the rules of izzat," (b) "negotiating tensions," and (c) "speaking out/breaking the 'rules.'" Findings highlighted new insights into the understanding of izzat and the implications these cultural concepts have for strategies in managing or silencing of psychological distress. Interviews illustrated tensions the participants experience when considering izzat, how these are negotiated to enable them to self-manage or seek help, and possible life experiences that might lead to self-harm and attempted suicide. Notably, cultural codes, in particular izzat, appear to vary over the life course and are influenced by migration.

Agency, activation and compatriots: the influence of social networks on health-seeking behaviours among Sri Lankan migrants and Anglo-Australians with depression

The nexus between social networks and illness behaviours is important in uptake of health care, however scant research has explored this relationship in South Asian migrants living with mental illness. We explored the interplay between culture, social networks and health seeking in Sri Lankan migrants and Anglo-Australians living with depression. Forty-eight in-depth interviews were conducted and data were analysed through the theoretical prism of the network episode model. Results showed that social networks were important in negotiating care. Decisions to initiate care occurred along a continuum of choice and agency; some took charge of their care, others were coerced into care, however some Sri Lankan migrants were led through various informal channels of care. Selective activation of compatriots - those perceived to understand mental illness-became increasingly important to participants through their illness careers. Compatriots were considered of greater benefit as participants progressed through depression than otherwise meaningful social networks based on ethnicity, culture and kinship. We argue that the role of social networks is pivotal in uptake of formal care, and engaging with communities to improve responses of social networks to mental illnesses may provide a bottom-up avenue for improving uptake of mental health services in migrant communities.

Acculturation, perceived discrimination, and psychological distress: Experiences of South Asians in Hong Kong

Although migration itself may not compromise the mental health of immigrants, the acculturative process can involve highly stressful factors that are specific to immigrant and minority status. Using structural equation modeling, this study examined the relations between acculturation orientations, perceived discrimination, acculturative stress, and psychological distress among 229 Pakistani and 218 Nepalese migrants living in Hong Kong. Although the initial hypothesized model was not confirmed, a modified model with good fit indices showed that acculturation orientation mediated the relationships of perceived discrimination and acculturative stress with psychological distress. Of all the factors in the model, acculturative stress had the strongest association with psychological distress.

The doctor's medicine and the ambiguity of amulets: life and suffering among Bangladeshi psychiatric patients and their families in London--an interview study--1

An interview study of 44 Bangladeshi patients and relatives in London demonstrated simultaneous trust in psychiatrists as well as in the widespread use of healing amulets. At the same time, local Islamic clerics and traditional healers were seen by many with some degree of suspicion. The authors offer an interpretation in which local healers and their methods are regarded ambivalently: the more distant biomedical framework fits with the newer modernising 'High' Islam (literate, scripturalist, puritanical, unitarian, urban, clerical, perhaps masculinist), as opposed to Hindu-inflected traditional Sufi Islam in Bangladesh (peasant, popular, syncretic, saintly, magical, ecstatic and possibly more sympathetic to women's experience).

Perceived Discrimination, Identification, Social Capital, and Well-Being

This study examined racism, ethnic and majority identification, cognitive aspects of social capital (i.e., a sense of trust), and perceived stress and evaluated the relationships between these variables and two indices of adjustment (physical health, psychological well-being) in three minority ethnic community samples in Scotland, United Kingdom. Pakistani ( n = 211, 101 female), Indian ( n = 155, 81 female), and African and Caribbean ( n = 244, 119 female) individuals participated in semistructured interviews. Racism was associated with higher levels of perceived stress, lower levels of social capital, higher levels of minority identity, and lower levels of majority identity. Racism was also associated with psychological well-being (though in different ways for different groups) and with poorer physical health. Minority identification was positively associated with psychological well-being and negatively with perceived stress, while majority identification was positively associated with social capital and negatively with physical health. Implications of these findings are discussed with reference to the literature.

Access to social capital and social support among South East Asian women with severe mental health problems: a cross-sectional survey

BACKGROUND

Migrant groups in the UK are at an increased risk of experiencing psychosis. In particular, South East Asian women are substantially more at risk of mental illness than men. Perceived social support and access to social capital are two important psychosocial factors, which may explain this differential risk.

AIMS

This study aimed to explore if migrant status was associated with the perception of social support and access to social capital of Punjabi women suffering from enduring mental illness.

METHOD

We conducted a cross-sectional survey of a homogeneous group of Punjabi women (n = 54). Outcome measures included the Multidimensional Scale of Perceived Social Support (MSPSS) and Resource Generator-UK (RG-UK).

RESULTS

No significant differences were found between the two generations on our outcome measures. However, univariate analysis revealed an association of socio-economic and demographic variables with the MSPSS and RG-UK. Linear regression confirmed that being employed, living with others and human capital predicted increased access to social capital.

CONCLUSIONS

Intervening to help this vulnerable group to enhance their social skills and to develop their social networks may improve their access to social capital and promote their recovery from mental illness.

Egyptian families caring for a relative with mental illness: a hermeneutic study

The care of people with mental illness often rests with their families. The way families manage this experience has been explored widely in the literature; however, the added complexity of migration has been given little attention. The difficulty of conducting research with people from non-English-speaking backgrounds often precludes their voices and experiences from being heard, further compounding marginalization and misunderstanding of their needs. The aim of this study was to understand the experience of Egyptian families caring for a relative with mental illness in Australia. Seven participants from Egyptian background, caring for a relative with mental illness, were included in this study. A hermeneutic phenomenological approach, informed by the work of Heidegger, was used. Data were collected through in-depth audio-taped interviews conducted in the Arabic language, which were then translated and transcribed in English. Data analysis revealed five themes: Why did it happen? How do I protect my loved ones? What has it done to me? What has it done to us? How do I survive? Findings of the study have the potential to raise health-care professionals' awareness of the needs of Egyptian families, their beliefs, values, and coping with mental illness.