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Pongthippat W, Östlund G, Darvishpour M, Kijsomporn J, Gustafsson LK. Illuminating health aspects for immigrant Thai women in Swedish transnational marriages. BMC Womens Health 2024; 24:337. [PMID: 38867221 PMCID: PMC11167763 DOI: 10.1186/s12905-024-03071-6] [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: 09/20/2021] [Accepted: 04/02/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Women who are migrants experience discrimination and face major risks, including sexual exploitation, trafficking, and violence, which affect their health and well-being. This study explored critical health incidents experienced by immigrant Thai women in marriage migration. METHODS A qualitative explorative approach with in-depth interviews was used. Forty immigrant Thai women who currently or previously had a Swedish spouse were recruited for the study. An inductive critical incident technique was used to collect and analyze the data as the first step. In a second deductive step, the Newman system model was used to categorize health dilemmas. RESULTS The women reported 438 critical health incidents in five main areas. Psychological health dilemmas included emotional abuse, feeling overwhelmed due to family responsibilities and the stress of leaving family behind. Sociocultural health dilemmas included transnational family duties or not performing family duties. Physiological health dilemmas included experiencing physical violence and environmental, domestic or work accidents. Developmental health dilemmas included failing health, difficulties upholding the duties expected of a spouse in the target culture and caring for an elderly husband. Spiritual health dilemmas included critical incidents in which the women perceived themselves to have failed in their hopes and duties as a wife, which intensified their dependence on faith, particularly the Buddhist concept of karma. CONCLUSION Professionals in health and welfare practices in Thailand together with professionals in Western countries who work with women in marriage migration situations need to recognize the psychological, sociocultural, physiological, developmental, and spiritual health dilemmas experienced by these women. Furthermore, civil organizations that meet Thai women in foreign countries, such as Buddhist cultural associations, would benefit from the multicultural knowledge revealed by the present study. This knowledge can facilitate healthcare and welfare support for women in marriage migration situations.
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Affiliation(s)
- Weerati Pongthippat
- School of Health, Care and Social Welfare, Mälardalen University, Box 325, Eskilstuna, 631 05, Sweden.
- Mental Health and Psychiatric Nursing Department, Boromarajonani College of Nursing, Udon Thani, Thailand.
| | - Gunnel Östlund
- School of Health, Care and Social Welfare, Mälardalen University, Box 325, Eskilstuna, 631 05, Sweden
| | - Mehrdad Darvishpour
- School of Health, Care and Social Welfare, Mälardalen University, Box 325, Eskilstuna, 631 05, Sweden
| | | | - Lena-Karin Gustafsson
- School of Health, Care and Social Welfare, Mälardalen University, Box 325, Eskilstuna, 631 05, Sweden
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2
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Santambrogio J, Ciscato V, Lorusso O, Wisidagamage Don P, Leon E, Miragliotta E, Capuzzi E, Colmegna F, Clerici M. The challenge of diagnosing cultural syndromes: A narrative review. Int J Soc Psychiatry 2024:207640241232335. [PMID: 38475713 DOI: 10.1177/00207640241232335] [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: 03/14/2024]
Abstract
BACKGROUND In 2022 the total world migrant population was 281 million (an increase of approximately 62% compared to year 2000), of whom 169 million were migrant workers. The number of refugees, asylum seekers and others in need of international protection increased by 22% compared to 2021. Research has shown that the forcibly displaced have high rates of mental disorders (including depression, post-traumatic stress disorder (PTSD) and anxiety), with an estimated prevalence almost 6 to 7 times higher than the general population. Given the increase of the overall migration phenomenon and the challenge raised by the cultural features concerning mental health, we consider that this is an area that requires close attention to ensure that culturally sensitive health services be available to the migrant and displaced population. AIMS The aim of this narrative review is to provide a background to the issue and take stock of what is currently available in the literature regarding culture-bound illnesses and the relevant diagnostic tools. METHODS A comprehensive search was performed in PubMed, Psychinfo, Embase, Google Scholar, organized in stages to assure inclusion of all the relevant studies. Of the 703 papers initially identified, only 30 papers finally satisfied the inclusion criteria. RESULTS Eleven diagnostic scales were found, only two of which are being used for displaced people. CONCLUSIONS Further work is required in this field, including a debate as to whether scales are indeed an appropriate tool for use with this population.
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Affiliation(s)
- Jacopo Santambrogio
- Adele Bonolis AS.FRA. Onlus Foundation, Vedano al Lambro, Monza, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Mental Health and Addiction Department, ASST Brianza, Monza, Italy
| | - Veronica Ciscato
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Mental Health and Addiction Department, ASST Brianza, Monza, Italy
| | - Ottavia Lorusso
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | | | - Elisabetta Leon
- Mental Health and Addiction Department, IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Elena Miragliotta
- Mental Health and Addiction Department, IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Enrico Capuzzi
- Mental Health and Addiction Department, IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Fabrizia Colmegna
- Mental Health and Addiction Department, IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Massimo Clerici
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Mental Health and Addiction Department, IRCCS San Gerardo dei Tintori, Monza, Italy
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3
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Lindberg LG, Carlsson J, Kristiansen M, Skammeritz S, Johansen KS. The Cultural Formulation Interview-Generating distance or alliance? A qualitative study of practice changes in Danish mental healthcare. Transcult Psychiatry 2022; 59:740-755. [PMID: 35331059 DOI: 10.1177/13634615211065617] [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: 01/20/2023]
Abstract
This article presents provider experiences with the Cultural Formulation Interview (CFI) in Danish mental healthcare for migrant patients. Semi-structured interviews with 17 providers and 20 recorded CFI sessions were analyzed with a constructivist grounded theory approach. Based on our empirical material, we endorse the CFI's ability to facilitate working alliance and a profound and contextually situated understanding of the patient. Further, the CFI supported less-experienced providers in investigating cultural issues. Conversely, we found that CFI questions about cultural identity and background evoked notions of distance and 'othering' in the encounter. Nine providers had felt discomfort and professional insecurity when the CFI compelled them to introduce explanatory frameworks of culture in the mental health assessment. Eleven providers had experienced that the abstract nature of the questions inhibited patient responses or led to short and stereotypical descriptions, which had limited analytical value. We describe the contradictory CFI experiences of alliance versus distance at three levels: 1) at the CFI instrument level; 2) at the organizational level; and 3) at the contextual and structural level. We demonstrate benefits and pitfalls of using the CFI with migrants in Denmark, which is an example of a European healthcare context where cultural consultation is not an integrated concept in health education programs and where the notion of culture is contentious due to negative political rhetoric on multiculturalism.We suggest that the CFI should be introduced with thorough training; focus on fidelity; and supervision in the clinical application and understanding of the concept of culture.
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Affiliation(s)
- Laura Glahder Lindberg
- Competence Centre for Transcultural Psychiatry, Mental Health Center Ballerup, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark.,Department of Public Health, University of Copenhagen, Denmark
| | - Jessica Carlsson
- Competence Centre for Transcultural Psychiatry, Mental Health Center Ballerup, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Maria Kristiansen
- Department of Public Health, University of Copenhagen, Denmark Center for Healthy Aging, University of Copenhagen, Denmark
| | - Signe Skammeritz
- Competence Centre for Transcultural Psychiatry, Mental Health Center Ballerup, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Katrine Schepelern Johansen
- Competence Centre for Dual Diagnosis, Mental Health Center Sct Hans, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
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Frankova I, Scheeres K, Menculini G, Cikrikcili U, Matei IC, Fellinger M, Riboldi I, Uzer-Kremers L, Küey L. Forcibly displaced persons and mental health: A survey of the experiences of Europe-wide psychiatry trainees during their training. Transcult Psychiatry 2022; 60:167-175. [PMID: 36344237 DOI: 10.1177/13634615221135421] [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: 11/09/2022]
Abstract
Many European countries have seen increasing refugee populations and asylum applications over the past decade. Forcibly displaced persons (FDPs) are known to be at higher risk of developing mental disorders and are in need of specific care. Thus, specific training for mental health professionals is recommended by international health organizations. The aim of this exploratory study was to assess the experience of clinical work with FDPs among psychiatric trainees in Europe and Central Asia as well as their interest and specific training received on this topic. An online questionnaire was designed by the Psychiatry Across Borders working group of the European Federation of Psychiatric Trainees (EFPT) and was distributed via email through local networks among European trainees from 47 countries between March 2017 and April 2019. Answers of 342 psychiatric trainees from 15 countries were included in the survey analysis. A majority of trainees (71%) had had contact with FDPs in the last year of their clinical work. Although three-quarters expressed a strong interest in the mental health of FDPs, only 35% felt confident in assessing and treating them. Specific training was provided to 25% of trainees; of this subset, only a quarter felt this training prepared them adequately. Skills training on transcultural competencies, post-traumatic stress disorder, and trauma management was regarded as essential to caring for refugees with confidence. Although psychiatric trainees are motivated to improve their skills in treating FDPs, a lack of adequate specific training has been identified. The development of practical skills training is essential. International online training courses could help meet this pressing need.
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Affiliation(s)
- Iryna Frankova
- Department of Medical Psychology, Psychosomatic Medicine and Psychotherapy, 123498Bogomolets National Medical University, Ukraine.,Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, The Netherlands
| | - Karl Scheeres
- Avon and Wiltshire Mental Health Partnership NHS Trust, Bristol, England
| | - Giulia Menculini
- Department of Psychiatry, 9309University of Perugia, Italy.,Italian Society of Psychiatry (SIP), Young Section-SIP Giovani, Italy
| | - Uğur Cikrikcili
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) - Magdeburg, Germany
| | - Ioan-Costin Matei
- Clinica Nutrimed, Romania.,Global Mental Health MSc Student, University of Glasgow, UK
| | - Matthäus Fellinger
- Department of Psychiatry and Psychotherapy, Division of Social Psychiatry, 27271Medical University of Vienna, Austria
| | - Ilaria Riboldi
- Italian Society of Psychiatry (SIP), Young Section-SIP Giovani, Italy.,60233Department of Medicine and Surgery, University of Milano Bicocca, Italy
| | - Laura Uzer-Kremers
- Department of Psychiatry and Addictology, Medical University of Amiens, France
| | - Levent Küey
- Psychiatry, Private practice, Istanbul, Turkey
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5
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Lindberg LG, Johansen KS, Kristiansen M, Skammeritz S, Carlsson J. Negotiating Engagement, Worthiness of Care and Cultural Identities Through Intersubjective Recognition: Migrant Patient Perspectives on the Cultural Formulation Interview in Danish Mental Healthcare. Cult Med Psychiatry 2021; 45:629-654. [PMID: 33170411 DOI: 10.1007/s11013-020-09694-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2020] [Indexed: 11/28/2022]
Abstract
This qualitative study presents migrant patient perspectives on using the Cultural Formulation Interview (CFI) in mental health assessments in Denmark. Empirical data consisted of 20 recorded CFI sessions and 16 patient interviews, coded with a constructivist grounded theory approach. Empirical findings prompted us to draw on the theoretical framework of intersubjective recognition in the analytical process. Our analysis showed how patients had multiple previous experiences of misrecognition in life and healthcare. This seemed to restrain their self-esteem and available positions for expressing preferences and reservations during the CFI and led to negotiations of worthiness of care. Despite occasional lack of flow and information in the recorded CFI sessions, patients subsequently recounted how they felt the CFI recognised the complexity and context of their cultural identities and illness narratives. Patients described how the CFI-guided provider approach of curiosity and empowerment carried significant meaning and left them feeling dignified, hopeful and engaged in future care. Intersubjective recognition is fundamental in all human interaction, but we argue that the recognising CFI approach is particularly important in vulnerable and asymmetrical mental health assessment encounters where access to care is determined and when working with migrants or other marginalised groups.
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Affiliation(s)
- Laura Glahder Lindberg
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region of Denmark, Maglevænget 21, 2750, Ballerup, Denmark. .,Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Katrine Schepelern Johansen
- Competence Centre for Dual Diagnosis, Mental Health Centre Sct. Hans, Mental Health Services of the Capital Region of Denmark, Roskilde, Denmark
| | - Maria Kristiansen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Signe Skammeritz
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region of Denmark, Maglevænget 21, 2750, Ballerup, Denmark
| | - Jessica Carlsson
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region of Denmark, Maglevænget 21, 2750, Ballerup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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6
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van Herwaarden A, Rommes EWM, Peters-Scheffer NC. Cultural competence in lifelong care and support for individuals with intellectual disabilities. ETHNICITY & HEALTH 2021; 26:922-935. [PMID: 30849248 DOI: 10.1080/13557858.2019.1591348] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 02/28/2019] [Indexed: 06/09/2023]
Abstract
Objectives: Although an extensive amount of research has been devoted to models defining cultural competence of healthcare professionals in short-term care, there is unclarity about the cultural competencies that professionals providing lifelong care and support should have. The current study aimed to explore which cultural competencies are used by these healthcare professionals, and whether these competencies enabled them to make cultural adaptations to their regular care practices.Design: To investigate cultural competencies and cultural adaptations, semi-structured in-depth interviews were conducted with eight professionals who provide lifelong care and support to individuals with intellectual disabilities. Five cultural competencies were explored: awareness, knowledge, skills, motivation, and encounters.Results: A thematic analysis of the interviews revealed that professionals providing lifelong care and support used all cultural competencies in their care practices. Moreover, our analysis suggested that these competencies could be categorized as either practical or analytical cultural competencies. Although these competencies were conditional in order to make cultural adaptations to care practices, the presence of cultural competencies did not automatically lead to these cultural adaptations.Conclusions: All five cultural competencies were used by professionals in lifelong care and support. Our analysis revealed that both practical and analytical cultural competencies were essential in providing culturally sensitive lifelong care and support. We additionally suggest that the cultural competence of professionals is necessary, but not sufficient, for making cultural adaptations to lifelong care and support for individuals with intellectual disabilities. In many cases, other factors also played a role in a professional's final decision to adapt their care practices.
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Affiliation(s)
- Aniek van Herwaarden
- Behavioural Science Institute, Department of Learning and Plasticity, Radboud University Nijmegen, Nijmegen, the Netherlands
- Driestroom, Elst, The Netherlands
| | - Els W M Rommes
- Gender and Diversity Studies, Radboud University Nijmegen, Nijmegen, the Netherlands
| | - Nienke C Peters-Scheffer
- Behavioural Science Institute, Department of Learning and Plasticity, Radboud University Nijmegen, Nijmegen, the Netherlands
- Driestroom, Elst, The Netherlands
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7
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Leiler A, Wasteson E, Holmberg J, Bjärtå A. A Pilot Study of a Psychoeducational Group Intervention Delivered at Asylum Accommodation Centers-A Mixed Methods Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8953. [PMID: 33271975 PMCID: PMC7730684 DOI: 10.3390/ijerph17238953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/27/2020] [Accepted: 11/28/2020] [Indexed: 12/11/2022]
Abstract
Asylum seekers suffer high levels of distress but have restricted access to mental health care. This paper constitutes an evaluation of a psycho-educational group intervention, called AMIN, which was provided at two asylum accommodation centers in Sweden. A mixed-methods approach was used. To assess potential effectiveness, acceptability, and feasibility, quantitative outcome measures were combined with qualitative information from interviews with both intervention participants and staff providing the intervention. Potential effectiveness in reducing symptoms of distress and insomnia and in increasing physical quality of life was found, even though the intervention participants suffered from more severe distress than expected. In general, the intervention seemed to be acceptable to both participants and staff, with concrete strategies seeming more meaningful than abstract psychological techniques. Finally, regardless of the asylum process itself being a complicating factor, the intervention seemed feasible to deliver to individuals with different backgrounds and conditions. Taken together, these results indicate that some sessions may need further elaboration, but also that the transition to a randomized control trial is reasonable.
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Affiliation(s)
- Anna Leiler
- Institution of Psychology and Social Work, Mid Sweden University, 831 25 Östersund, Sweden; (E.W.); (J.H.); (A.B.)
| | - Elisabet Wasteson
- Institution of Psychology and Social Work, Mid Sweden University, 831 25 Östersund, Sweden; (E.W.); (J.H.); (A.B.)
| | - Joanna Holmberg
- Institution of Psychology and Social Work, Mid Sweden University, 831 25 Östersund, Sweden; (E.W.); (J.H.); (A.B.)
- Region Örebro County, 703 54 Örebro, Sweden
| | - Anna Bjärtå
- Institution of Psychology and Social Work, Mid Sweden University, 831 25 Östersund, Sweden; (E.W.); (J.H.); (A.B.)
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8
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Björkenstam E, Helgesson M, Amin R, Mittendorfer-Rutz E. Mental disorders, suicide attempt and suicide: differences in the association in refugees compared with Swedish-born individuals. Br J Psychiatry 2020; 217:679-685. [PMID: 31608856 DOI: 10.1192/bjp.2019.215] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Mental disorders are associated with an elevated risk for suicide attempt and suicide. Whether the strength of the associations also holds for refugees is unclear. AIMS To examine the relationship between specific mental disorders and suicide attempt and suicide in refugees and Swedish-born individuals. METHOD This longitudinal cohort study included 5 083 447 individuals aged 16-64 years, residing in Sweden in 2004, where 196 757 were refugees. Mental disorders were defined as having a diagnosis in psychiatric care during 2000-2004. Estimates of risk of suicide attempt and suicide were calculated as hazard ratios with 95% confidence intervals. Adjustments were made for important confounding factors, including history of attempt. The reference group comprised Swedish-born individuals without mental disorders. RESULTS Rates for suicide attempt in individuals with a mental disorder were lower in refugees compared with Swedish-born individuals (480 v. 850 per 100 000 person-years, respectively). This pattern was true for most specific disorders: compared with the reference group, among refugees, multivariable-adjusted hazard ratios for suicide attempt ranged from 3.0 (anxiety) to 7.4 (substance misuse), and among Swedish-born individuals, from 4.9 (stress-related disorder) to 9.3 (substance misuse). For schizophrenia, bipolar disorder and personality disorder, estimates for suicide attempt were comparable between refugees and Swedish-born individuals. Similar patterns were seen for suicide. CONCLUSIONS For most mental disorders, refugees were less likely to be admitted to hospital for suicide attempt or die by suicide compared with Swedish-born individuals. Further research on risk and protective factors for suicide attempt and suicide among refugees with mental disorders is warranted. DECLARATION OF INTEREST None.
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Affiliation(s)
- Emma Björkenstam
- Assistant Professor, Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Magnus Helgesson
- Senior Postdoctoral Research Fellow, Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Ridwanul Amin
- Doctoral student, Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Ellenor Mittendorfer-Rutz
- Professor of Insurance Medicine, Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
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9
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Carballeira Carrera L, Lévesque-Daniel S, Radjack R, Moro MR, Lachal J. Clinical Approaches to Cultural Diversity in Mental Health Care and Specificities of French Transcultural Consultations: A Scoping Review. Front Psychiatry 2020; 11:579147. [PMID: 33192718 PMCID: PMC7652727 DOI: 10.3389/fpsyt.2020.579147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/02/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Cultural context substantially affects the experience and clinical expression of psychiatric diseases, while cultural factors limit both access to and effectiveness of care, especially for migrant families requiring specific types of services. We conducted a scoping review on psychiatric services adapted to cultural diversity, to compare these models of care to the French Transcultural Psychotherapy model. Methods: Systematic electronic search of databases (PubMed and PsycINFO), manual search of archives of journals dealing with transcultural psychiatry, and consultations with international experts, to identify all papers describing clinical models devoted to psychiatric care for migrants, published between January 1990 and October 2018. Narrative synthesis of the included articles. Results: The study included 29 papers. The specificities of psychiatric services for migrant families are linked to the host country's migration patterns and citizenship model. In English-speaking countries, specialized services for ethnic minorities offer ethnic matching of the therapist and patient. In Canada, indirect transcultural consultation services have existed since the late 1990s. Australia emphasizes the networking of consultation services and professional training in cultural competence, while the Nordic countries (Sweden, Finland, Norway, and Denmark) focus management on trauma. In France, psychotherapy services, with flexible numbers of therapists involved according to the situation, have existed since 1990. Discussion: Most initiatives place emphasis on training and supervision, in an indirect approach not specifically focused on the patient, or offer cultural matching of patient and therapist. The French transcultural approach, on the contrary, makes the family's culture and its cultural diversity an integral part of the therapy process.
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Affiliation(s)
- Laura Carballeira Carrera
- Alicia Koplowitz Short-Term Fellowship, Madrid, Spain
- APHP, Hôpital Cochin, Maison de Solenn, Paris, France
| | - Sarah Lévesque-Daniel
- APHP, Hôpital Cochin, Maison de Solenn, Paris, France
- Centre integré universitaire de santé et de services sociaux de l'Est-de-l'île-de-Montréal (CIUSSS) du Nord-de-l'Île-de-Montréal, Université de Montréal, Montréal, QC, Canada
| | - Rahmeth Radjack
- APHP, Hôpital Cochin, Maison de Solenn, Paris, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
| | - Marie Rose Moro
- APHP, Hôpital Cochin, Maison de Solenn, Paris, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
- Université de Paris, PCPP, Boulogne-Billancourt, France
| | - Jonathan Lachal
- APHP, Hôpital Cochin, Maison de Solenn, Paris, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
- Université de Paris, PCPP, Boulogne-Billancourt, France
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10
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Lindberg LG, Mundy SS, Kristiansen M, Johansen KS, Carlsson J. Satisfaction with mental health treatment among patients with a non-Western migrant background: a survey in a Danish specialized outpatient mental health clinic. Eur J Public Health 2020; 29:700-705. [PMID: 31155672 DOI: 10.1093/eurpub/ckz090] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Global migration increases ethnic and cultural diversity and demands mental health services to adapt to provide all patients with equal access to good quality care. Patient satisfaction surveys can inform this service delivery, thus we explored patient satisfaction among non-Western migrants receiving treatment in a Danish specialized outpatient mental health clinic [Competence Centre for Transcultural Psychiatry (CTP)]. METHODS We used multivariate logistic regression models to estimate associations between 'Overall treatment satisfaction' and treatment-related items plus potential confounders from a cross-sectional patient satisfaction survey (n = 686). The satisfaction questionnaire was a self-report measurement tool developed locally at CTP. Participants were non-Western migrants above 18 years with Post-Traumatic Stress Disorder (PTSD) or depression diagnoses according to ICD-10. RESULTS Most participants (n = 497; 82.6%) reported overall satisfaction with their mental health treatment, but less than half (n = 311; 48.8%) reported an improvement in health and situation after end of treatment. Participants who experienced a subjective improvement in their health and situation had significantly higher odds of being satisfied with their mental health treatment [odds ratio (OR) = 8.5, 95% confidence interval (CI): 4.0-18.1]. Perceptions of influence on the treatment course (OR = 4.7, 95% CI: 2.4-9.2), and of understanding and respect for one's cultural background (OR = 3.4, 95% CI: 1.5-7.6) were significantly associated with treatment satisfaction. Age and sex were insignificant in the final regression model. CONCLUSIONS Implications for practice based on our findings are to enhance person-centred care and shared decision-making with all patients regardless of cultural background and to prioritize pre- and postgraduate training in cultural competences and cultural humility for healthcare providers.
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Affiliation(s)
- Laura Glahder Lindberg
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region of Denmark, Ballerup, Denmark.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Sara Skriver Mundy
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region of Denmark, Ballerup, Denmark
| | - Maria Kristiansen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | | | - Jessica Carlsson
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region of Denmark, Ballerup, Denmark
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11
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Søegaard EGI, Kan Z, Koirala R, Hauff E, Thapa SB. Variations in psychiatric morbidity between traumatized Norwegian, refugees and other immigrant patients in Oslo. Nord J Psychiatry 2020; 74:390-399. [PMID: 31961250 DOI: 10.1080/08039488.2020.1714724] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background: There is a lack of clinical studies that focus on different psychiatric disorders after trauma and the relationship with migration status.Purpose: To examine differences in psychiatric morbidity in traumatized patients referred to psychiatric treatment in Southern Oslo.Materials and methods: Hundred and ten patients with trauma background attending an outpatient clinic in Southern Oslo were studied. Forty-four of the participants (40%) were ethnic Norwegians, 25 (22.7%) had refugee background and 41 (37.3%) were first- or second-generation immigrants without refugee background. Thorough diagnostic assessment was done by experienced psychiatrists through several structured clinical interviews and self-report questionnaires.Results: Ninety-eight patients (89%) were diagnosed with at least one Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR) disorder. There was a clear difference in the presentation of certain psychiatric disorders between the groups. Ethnic Norwegian patients were more likely to have anxiety disorders: agoraphobia, social phobia and panic disorder than non-refugee immigrant patients. They also had higher rates of alcohol abuse/dependence. Somatoform pain disorder was more common in both the refugee and other-immigrant groups than among the ethnic Norwegian patients. The refugee patients had significantly more major depressive disorder, post-traumatic stress disorder (PTSD) and both co-occurring.Conclusion: Trauma is frequently associated with depression, anxiety disorders, somatoform pain disorder and PTSD in a clinical population. The clinical presentation and comorbidity of these disorders seem to vary significantly between traumatized patients with Norwegian, refugee and non-refugee immigrant backgrounds. After a major trauma, refugees may be at greater risk for both PTSD and depression than other immigrants and the native population.
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Affiliation(s)
- Erik Ganesh Iyer Søegaard
- Department of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Department of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Zhanna Kan
- Department of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Rishav Koirala
- Department of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Brain and Neuroscience Center, Kathmandu, Nepal
| | - Edvard Hauff
- Department of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Department of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Suraj Bahadur Thapa
- Department of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Department of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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12
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Perceptions of transnational family responsibilities’ effects on subjective health and wellness – voices of Thai immigrant women. INTERNATIONAL JOURNAL OF MIGRATION, HEALTH AND SOCIAL CARE 2020. [DOI: 10.1108/ijmhsc-12-2019-0104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Globalisation provides new opportunities for immigrant women to supply financial benefits transnationally to uphold their families in their home countries. The purpose of this study is to explore the experiences of Thai immigrant women regarding transnational family responsibilities effects on their health and wellness.
Design/methodology/approach
Qualitative data were collected using semi-structured interviews with 40 Thai immigrant women, of which 34 described having transnational family responsibilities. The transcribed data were analysed using a phenomenographic approach.
Findings
The findings revealed five structural aspects of transnational family responsibilities of Thai immigrant women: being a dutiful daughter, being a caring mother, being a kind relative, being a “giving” person and striving for a wealthy life. The interviewees seldom encountered enough support from the spouse in handling their transnational family responsibilities. In general, a transnational marriage includes family responsibilities that are continuous and that often is the cause of migration.
Practical implications
This paper illuminates the transnational responsibilities of marriage migration and argues for women’s rights of culturally congruent health care.
Originality/value
Traditionally Thai women’s values are based on how they handle family responsibilities and acknowledging own health needs are not. These interviewees perceived doubled burden in terms of family responsibilities and workload in employed work, which contributed to poor health and wellness.
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13
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Mental disorders and suicidal behavior in refugees and Swedish-born individuals: is the association affected by work disability? Soc Psychiatry Psychiatr Epidemiol 2020; 55:1061-1071. [PMID: 31897579 PMCID: PMC7395008 DOI: 10.1007/s00127-019-01824-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 12/24/2019] [Indexed: 12/03/2022]
Abstract
BACKGROUND Among potential pathways to suicidal behavior in individuals with mental disorders (MD), work disability (WD) may play an important role. We examined the role of WD in the relationship between MD and suicidal behavior in Swedish-born individuals and refugees. METHODS The study cohort consisted of 4,195,058 individuals aged 16-64, residing in Sweden in 2004-2005, whereof 163,160 refugees were followed during 2006-2013 with respect to suicidal behavior. Risk estimates were calculated as hazard ratios (HR) with 95% confidence intervals (CI). The reference groups comprised individuals with neither MD nor WD. WD factors (sickness absence (SA) and disability pension (DP)) were explored as potential modifiers and mediators. RESULTS In both Swedish-born and refugees, SA and DP were associated with an elevated risk of suicide attempt regardless of MD. In refugees, HRs for suicide attempt in long-term SA ranged from 2.96 (95% CI: 2.14-4.09) (no MD) to 6.23 (95% CI: 3.21-12.08) (MD). Similar associations were observed in Swedish-born. Elevated suicide attempt risks were also observed in DP. In Swedish-born individuals, there was a synergy effect between MD, and SA and DP regarding suicidal behavior. Both SA and DP were found to mediate the studied associations in Swedish-born, but not in refugees. CONCLUSION There is an effect modification and a mediating effect between mental disorders and WD for subsequent suicidal behavior in Swedish-born individuals. Also for refugees without MD, WD is a risk factor for subsequent suicidal behavior. Particularly for Swedish-born individuals with MD, information on WD is vital in a clinical suicide risk assessment.
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14
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Høyvik AC, Lie B, Willumsen T. Dental anxiety in relation to torture experiences and symptoms of post-traumatic stress disorder. Eur J Oral Sci 2018; 127:65-71. [PMID: 30444297 DOI: 10.1111/eos.12592] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2018] [Indexed: 11/30/2022]
Abstract
Torture victims often show symptoms of dental anxiety when receiving dental care, but little systematic research is available. The purpose of this study was to explore torture experiences, symptoms of post-traumatic stress disorder (PTSD), and dental anxiety in refugees in Norway and to test the hypothesis that refugees with torture experiences are more prone to dental anxiety than refugees with no such experiences. A total of 173 refugees were interviewed shortly after an oral examination. The Modified Dental Anxiety Scale (MDAS) and the Harvard Trauma Questionnaire-PTSS16 were administered verbally through attending interpreters. Among torture victims (47%, n = 81), the prevalence of torture experiences involving mouth or teeth was 35% and 23%, respectively. Harvard Trauma Questionnaire mean sum scores were statistically significantly higher in torture victims (34.3 vs. 24.8). Torture survivors report a larger number of symptoms of PTSD, and dental anxiety shows a higher prevalence in refugees reporting PTSD symptoms than in refugees who do not report such symptoms. When analysed using logistic regression models, the data showed the odds of high levels of dental anxiety being 6.1 times higher in refugees with torture experiences compared with other refugees and 9.3 times higher in torture victims with PTSD symptoms. Oral health professionals should be aware of these associations when providing dental care to refugees. The hypothesis that tortured refugees are more prone to dental anxiety is supported.
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Affiliation(s)
- Ann C Høyvik
- Department of Pediatric Dentistry and Behavioral Science, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Birgit Lie
- Sorlandet Hospital, Kristiansand, Norway
| | - Tiril Willumsen
- Department of Pediatric Dentistry and Behavioral Science, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
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15
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Puzo Q, Mehlum L, Qin P. Rates and characteristics of suicide by immigration background in Norway. PLoS One 2018; 13:e0205035. [PMID: 30265720 PMCID: PMC6161913 DOI: 10.1371/journal.pone.0205035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 09/18/2018] [Indexed: 11/30/2022] Open
Abstract
Suicide mortality among immigrant groups is an important health issue, particularly in countries with growing segments of immigrant populations such as Norway. Through linkage of Norwegian national registers we wanted to estimate suicide rates (per 100,000 population) in immigrant groups and to profile characteristics of suicide by immigration background with respect to sex, age, method and seasonality of suicide as well as time since immigrating to Norway. Among all 11,409 suicides during 1992-2012, 1,139 (10%) were individuals with an immigration background. Suicide rate was lower in first-generation immigrants (foreign-born persons to two foreign-born parents) than native Norwegians (9.53 vs 12.22, P < 0.01), with a significant difference confined to male rates only. Foreign-born persons with at least one Norwegian-born parent had significantly higher suicide rates than natives in both sexes (22.42 vs 18.03 in males, 11.67 vs 6.54 in females, P < 0.01). The most frequently used suicide method in all the population groups was hanging; this method accounted for 44.0% of all suicides of first-generation immigrants, 45.2% of all suicides of foreign-born persons with at least one Norwegian-born parent, and 35.4% of all suicides of natives. Suicide by firearms accounted for a much smaller proportion of cases of first-generation immigrants (6.7%) and foreign-born persons with at least one Norwegian-born parent (6.8%) than cases of native Norwegians (20.7%). In terms of monthly distribution, suicides of first-generation immigrants displayed two peaks, in May and in November (P = 0.01). More than 25% of all first-generation immigrant suicides occurred in the first five years after immigration; but differences in time since immigration were observed by sex and country group of origin, in particular among those aged 35 years or less when moving to Norway. In conclusion, there are notable differences in characteristics of suicides by immigration background. Knowledge of immigrant mortality according to suicide method, seasonality of suicide, and time since immigration may be useful when planning suicide preventive measures.
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Affiliation(s)
- Quirino Puzo
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lars Mehlum
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ping Qin
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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16
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Helgesson M, Tinghög P, Niederkrotenthaler T, Saboonchi F, Mittendorfer-Rutz E. Labour-market marginalisation after mental disorders among young natives and immigrants living in Sweden. BMC Public Health 2017; 17:593. [PMID: 28645250 PMCID: PMC5481931 DOI: 10.1186/s12889-017-4504-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 06/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim was to investigate the associations between mental disorders and three different measures of labour-market marginalisation, and differences between native Swedes and immigrants. METHODS The study comprised 1,753,544 individuals, aged 20-35 years, and resident in Sweden 2004. They were followed 2005-2011 with regard to disability pension, sickness absence (≥90 days) and unemployment (≥180 days). Immigrants were born in Western countries (Nordic countries, EU, Europe outside EU or North-America/Oceania), or in non-Western countries (Africa, Asia or South-America). Mental disorders were grouped into seven subgroups based on a record of in- or specialised outpatient health care 2001-2004. Hazard ratios (HRs) with 95% confidence intervals (CIs) were computed by Cox regression models with both fixed and time-dependent covariates and competing risks. We also performed stratified analyses with regard to labour-market attachment. RESULTS Individuals with mental disorders had a seven times higher risk of disability pension, a two times higher risk of sickness absence, and a 20% higher risk of unemployment than individuals without mental disorders. Individuals with personality disorders and schizophrenia/non-affective psychoses had highest risk estimates for having disability pension and long-term sickness absence, while the risk estimates of long-term unemployment were similar among all subgroups of mental disorders. Among persons with mental disorders, native Swedes had higher risk estimates for disability pension (HR:6.6; 95%CI:6.4-6.8) than Western immigrants (4.8; 4.4-5.2) and non-Western immigrants (4.8; 4.4-5.1), slightly higher risk estimates for sickness absence (2.1;2.1-2.2) than Western (1.9;1.8-2.1), and non-Western (1.9;1.7-2.0) immigrants but lower risk estimates for unemployment (1.4;1.3-1.4) than Western (1.8;1.7-1.9) and non-Western immigrants (2.0;1.9-2.1). There were similar risk estimates among sub-regions within both Western and non-Western countries. Stratification by labour-market attachment showed that the risk estimates for immigrants were lower the more distant individuals were from gainful employment. CONCLUSIONS Mental disorders were associated with all three measures of labour-market marginalisation, strongest with subsequent disability pension. Native Swedes had higher risk estimates for both disability pension and sickness absence, but lower risk estimates for unemployment than immigrants. Previous labour-market attachment explained a great part of the association between immigrant status and subsequent labour-market marginalisation.
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Affiliation(s)
- Magnus Helgesson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Petter Tinghög
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden
- Red cross University, College, Stockholm, Box, 1059 141 21 Huddinge, Sweden
| | - Thomas Niederkrotenthaler
- Department of Social and Preventive Medicine, Medical University Vienna, Center for Public Health, Spitalgasse 23, 1090 Vienna, Austria
| | - Fredrik Saboonchi
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden
- Red cross University, College, Stockholm, Box, 1059 141 21 Huddinge, Sweden
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden
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17
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Pantziaras I, Fors U, Ekblad S. Innovative training with virtual patients in transcultural psychiatry: the impact on resident psychiatrists' confidence. PLoS One 2015; 10:e0119754. [PMID: 25794169 PMCID: PMC4368761 DOI: 10.1371/journal.pone.0119754] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 02/03/2015] [Indexed: 12/04/2022] Open
Abstract
Background Virtual patients are now widely accepted as efficient and safe training tools in medical education, but very little is known about their implementation in psychiatry, especially in transcultural clinical care of traumatized refugee patients. Objective This study aimed at assessing the impact of training with a virtual patient on confidence in providing clinical care for traumatized refugee patients. Methods The authors developed an educational tool based on virtual patient methodology portraying the case of “Mrs. K”, a traumatized refugee woman with symptoms of PTSD and depression. A group (N=32) of resident psychiatrists tested the system and their confidence in different aspects of providing clinical care for this patient group was evaluated pre- and post-test by using a validated confidence questionnaire. Cronbach’s α was calculated for all clusters. Changes between pre- and post-test were compared by using the matched-pair t-test, binomial distribution for exact significance test and a calculation of effect sizes (Cohen’s d). Results A statistically significant improvement was exhibited in overall confidence (mean Δ: 0.34; p<0.0001; d: 0.89) as well as in four more specific domains of clinical care, with the area of identifying and evaluating trauma-related diagnoses and disability showing the most prominent improvement (mean Δ: 0.47; p<0.0001; d: 1.00). Conclusions This VP-system can lead to physicians’ improvement of confidence in providing transcultural clinical care for traumatized refugee patients. Further research is required to investigate improvement in actual performance and cognitive outcomes with several VPs and in a long-term effect perspective.
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Affiliation(s)
- Ioannis Pantziaras
- Cultural Medicine Unit, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Uno Fors
- Department of Computer and Systems Sciences, Stockholm University, Stockholm, Sweden
| | - Solvig Ekblad
- Cultural Medicine Unit, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
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18
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Pantziaras I, Fors U, Ekblad S. Training with virtual patients in transcultural psychiatry: do the learners actually learn? J Med Internet Res 2015; 17:e46. [PMID: 25689716 PMCID: PMC4376199 DOI: 10.2196/jmir.3497] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 10/21/2014] [Accepted: 11/08/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The rapid increase in the number of patients with diverse ethnic backgrounds and previous exposure to severe mental trauma dictates the need for improvement in the quality of transcultural psychiatric health care through the development of relevant and effective training tools. OBJECTIVE This study aimed to evaluate the impact of training with a virtual patient on the learner's knowledge of posttraumatic stress disorder symptoms, clinical management, and basic communication skills. METHODS The authors constructed an interactive educational tool based on virtual patient methodology that portrayed a refugee with severe symptoms of posttraumatic stress disorder and depression. A total of 32 resident psychiatrists tested the tool and completed a pre-interaction and post-interaction knowledge test, including skills, at the time and several weeks later. RESULTS All of the participants (N=32) completed the pre-interaction and post-interaction test, and 26 (81%) of them completed the online follow-up test. The mean pre-interaction score was 7.44 (male: 7.08, female: 7.65, no statistical significance). The mean post-interaction score was 8.47, which was significantly higher (P<.001) than the pre-interaction score (mean score 7.44). The mean score for the follow-up test several weeks later was 8.38, higher than the pre-interaction score by 0.69 points but not statistically significant. CONCLUSIONS Our results suggest that virtual patients can successfully facilitate the acquisition of core knowledge in the field of psychiatry, in addition to developing skills such as clinical reasoning, decision making, and history taking. Repeated training sessions with virtual patients are proposed in order to achieve sustainable educational effects.
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Affiliation(s)
- Ioannis Pantziaras
- Cultural Medicine Unit, Department of Learning, Informatics, Management and Ethics (LIME), Stockholm, Sweden.
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19
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Ekblad S, Persson-Valenzuela UB. Lifestyle course as an investment in perceived improved health among newly arrived women from countries outside Europe. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:10622-40. [PMID: 25321877 PMCID: PMC4210998 DOI: 10.3390/ijerph111010622] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 09/23/2014] [Accepted: 10/10/2014] [Indexed: 11/16/2022]
Abstract
Family reunification was the most common reason (34%) for resettlement in Sweden in 2013. About one-fifth of the population is foreign-born. This study used mixed methods to evaluate a culturally tailored clinical health-promotion intervention. The intervention was conducted by licensed clinicians and a local coordinator. Sessions were five-weeks long, two hours a week. The quantitative data cover results from 54 participants, mainly Arabic and Somali-speaking, who participated in 10 groups. The participants' perceived health improved significantly over the three measures. They also shared that their health significantly improved according to moderate effect size. The qualitative data, analyzed using revised content analysis, reflected one general theme: "the intervention is an investment in perceived improved health", and four categories: "perceived increased health literacy", "strength, empowerment and security", "finding a new lifestyle", and "the key to entry into Swedish society is language". An intervention focusing on the prevention of ill-health, on health as a human right, and on empowerment, and aimed at female newcomers, has practical implications.
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Affiliation(s)
- Solvig Ekblad
- Cultural Medicine Unit, Department of Learning, Information, Management and Ethics, Karolinska Institutet, SE-171 77 Stockholm, Sweden.
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