Attitudes towards psychopharmacology and psychotherapy in psychiatric patients with and without migration background

Attitudes Toward Psychotherapeutic Treatment and Health Literacy in a Large Sample of the General Population in Germany: Cross-Sectional Study

BACKGROUND

Prevalences of mental disorders are increasing worldwide. However, many people with mental health problems do not receive adequate treatment. An important factor preventing individuals from seeking professional help is negative attitudes toward psychotherapeutic treatment. Although a positive shift in attitudes has been observed in recent years, there is still substantial stigma surrounding psychotherapeutic treatment. First studies have linked higher health literacy with more positive attitudes toward psychotherapy, but more research is needed in this area.

OBJECTIVE

This study aimed to examine how general and mental health literacy are associated with attitudes toward psychotherapeutic treatment in Germany. Additionally, associations between sociodemographic factors, experience with psychotherapy, and attitudes toward psychotherapy were explored.

METHODS

A random sample was drawn from a panel representative of the German-speaking population with internet access in Germany and invited to participate in the study via email. Overall, 2000 individuals aged ≥16 years completed the web-based survey with standardized questionnaires in September and October 2022. Attitudes toward psychotherapy and both general and mental health literacy were assessed using the Questionnaire on Attitudes Towards Psychotherapeutic Treatment (QAPT) with 2 subscales ("positive attitudes" and "non-acceptance of society"), the European Health Literacy Survey instrument (HLS-EU-Q16) and the Mental Health Literacy Tool for the Workplace (MHL-W-G). Associations between the questionnaire scales were assessed with Pearson correlations. Additionally, basic sociodemographic information and information on personal and family experiences with psychotherapy were collected. Pearson correlations (age), ANOVAs (level of education and subjective social status), and t tests (experience with psychotherapy, gender, and migration background) were used to analyze how these relate to attitudes toward psychotherapy.

RESULTS

More favorable attitudes toward psychotherapy and lower perceived societal nonacceptance were found in those with higher general (r=0.14, P<.001; r=-0.32, P<.001, respectively) and mental health literacy (r=0.18, P<.001; r=-0.23, P<.001, respectively). Participants with treatment experience for mental health problems (t1260.12=-10.40, P<.001, Cohen d=-0.49; t1050.95=3.06, P=.002, Cohen d=0.16) and who have relatives with treatment experience (t1912.06=-5.66, P<.001, Cohen d=-0.26; t1926=4.77, P<.001, Cohen d=0.22) reported more positive attitudes and higher perceived societal acceptance than those without treatment experience. In terms of sociodemographic differences, being a woman (t1992=-3.60, P<.001, Cohen d=-0.16), younger age (r=-0.11, P<.001), higher subjective social status (F2,1991=5.25, P=.005, η2=.005), and higher levels of education (F2,1983=22.27, P<.001, η2=.021) were associated with more positive attitudes toward psychotherapeutic treatment. Being a man (t1994=5.29, P<.001, Cohen d=0.24), younger age (r=-0.08, P<.001), and lower subjective social status (F2,1993=7.71, P<.001, η2=.008) were associated with higher perceived nonacceptance of psychotherapy.

CONCLUSIONS

Positive associations between attitudes toward psychotherapy and both general and mental health literacy were delineated. Future studies should investigate whether targeted health literacy interventions directed at individuals with lower general and mental health literacy might also help to improve attitudes toward psychotherapeutic treatment and help-seeking behavior.

Exploring the Barriers and Facilitators in the Management of Childhood Trauma and Violence Exposure Intervention in the Vhembe District of the Limpopo Province, South Africa

Research has shown that barriers and facilitators in psychotherapy exhibit similarities. The authors of this study are of the view that to effectively address the difficulties encountered in psychotherapy for children and adolescents, it is crucial to consider the points of view of professionals who have firsthand encounters with children. The purpose of this study was to effectively explore barriers and facilitators in the treatment of children exposed to trauma and violence. Exploratory and descriptive methods, as components of a qualitative research design, were employed to investigate and articulate the barriers and facilitators involved in managing childhood trauma. An advertisement was used to recruit participants. It was developed and distributed to psychologists and social workers recommended by the Thohoyandou Victim Empowerment Programme. Seventeen professionals were individually interviewed using semi-structured interview schedules. The interviews were recorded, transcribed verbatim, and analysed using interpretative phenomenological analysis (IPA). The findings of the study indicated a lack of commitment from parents in honouring appointments, financial challenges, a fear of perpetrators associated with the poor reporting of incidences, professional boundaries, and referral route challenges. Familiar facilitators in the management of childhood trauma included continuous training and workshops for all people working with childhood trauma and violence, the employment of more victim advocates, and awareness campaigns. Additionally, the referral pathway for traumatised children presents logistical, psychological, and educational hurdles, underscoring the complex nature of meeting the needs of these vulnerable populations within the healthcare system. In conclusion, even while the currently available research supports the barriers and facilitators for this population, more investigation is required to examine how these factors affect treatment outcomes, particularly in community-based settings.

Use of benzodiazepine and related drugs in migrants and Finnish-born persons: a nationwide register-based study

AIMS

Benzodiazepines and related drugs (BZDR) are often used longer than generally recommended. The aim is to study patterns of use among migrant and Finnish-born users of BZDR, and to identify factors that are associated with long-term use and BZDR polytherapy.

METHODS

This register-based study includes a nationwide sample of migrants (n=8729) and their Finnish-born controls (n=11 388) who had purchased BZDR in 2011-2014, but not in 2009-2010. Information on drug purchases was obtained from the National Prescription Register and the duration of drug use was estimated using PRE2DUP method. The main outcomes were long-term use of BZDR, polytherapy and time until discontinuation of BZDR use. Sociodemographic variables and information on preceding psychiatric diagnoses were included as covariates. Logistic and Cox regression analyses were the statistical methods used.

RESULTS

Only migrants from Sub-Saharan Africa were more likely to discontinue the medication once initiated than Finnish-born users. Migrants were significantly less likely to be long-term users (adjusted odds ratio 0.79, 95% CI 0.70-0.89) or polytherapy users (aOR 0.90, 95% CI 0.84-0.97) of BZDR compared with Finnish-born participants.

CONCLUSIONS

Migrants had less long-term and concomitant use of several BZDR than Finnish-born participants. The pattern of use is more optimal among migrants, but it may also reflect poorer access to mental health treatment.

Risk of psychopathology following traumatic events among immigrants and native-born persons in Denmark

PURPOSE

Immigrants may have increased risk of mental disorders compared with native-born persons. We aimed to expand the limited research on immigrants' posttraumatic psychopathology related to traumatic experiences in their country of resettlement.

METHODS

We obtained data from a cohort of Danish residents with ≥ 1 traumatic event recorded in health and administrative national registries during 1994-2016. We calculated risks of posttraumatic stress disorder (PTSD), depression, and substance use disorders (SUD) within 5 years post-trauma among native-born Danes and immigrants who had been in Denmark for ≥ 10 years at the time of their index trauma (including immigrants overall and immigrants from specific regions). Risks were compared via age- and sex-standardized risk ratios (SRR) with 95% confidence intervals (CI). We restricted to persons with no record of the disorder under investigation in the 10 years pre-trauma, and stratified by non-interpersonal (e.g., transport accidents) versus interpersonal trauma (e.g., assaults).

RESULTS

Following non-interpersonal trauma, immigrants were more likely than native-born Danes to be diagnosed with PTSD (SRR = 5.2, 95% CI 4.6, 5.9), about as likely to be diagnosed with depression (SRR = 0.98, 95% CI 0.92, 1.1), and less likely to be diagnosed with SUD (SRR = 0.89, 95% CI 0.82, 0.95). Results were similar following interpersonal trauma, except the SRR for PTSD was reduced in magnitude (SRR = 3.0, 95% CI 1.7, 5.4). There were differences by region of birth.

CONCLUSION

Immigrants to Denmark have higher risk of PTSD following traumatic experiences than do native-born Danes, possibly due to the combined influence of adverse pre-, peri-, and/or post-migration experiences.

Depression among Turkish and Moroccan immigrant populations in Northwestern Europe: a systematic review of prevalence and correlates

BACKGROUND

This systematic review aimed to synthesize the prevalence and correlates of depressive disorders and symptoms of Turkish and Moroccan immigrant populations in Northwestern Europe, formulating evidence-informed recommendations for clinical practice.

METHODS

We conducted a systematic search in PsycINFO, MEDLINE, Science Direct, Web of Knowledge, and Cochrane databases for records up to March 2021. Peer-reviewed studies on adult populations that included instruments assessing prevalence and/or correlates of depression in Turkish and Moroccan immigrant populations met inclusion criteria and were assessed in terms of methodological quality. The review followed the relevant sections of the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting (PRISMA) guideline.

RESULTS

We identified 51 relevant studies of observational design. Prevalence of depression was consistently higher among people who had an immigrant background, compared to those who did not. This difference seemed to be more pronounced for Turkish immigrants (especially older adults, women, and outpatients with psychosomatic complaints). Ethnicity and ethnic discrimination were identified as salient, positive, independent correlates of depressive psychopathology. Acculturation strategy (high maintenance) was related to higher depressive psychopathology in Turkish groups, while religiousness appeared protective in Moroccan groups. Current research gaps concern psychological correlates, second- and third-generation populations, and sexual and gender minorities.

CONCLUSION

Compared to native-born populations, Turkish immigrants consistently showed the highest prevalence of depressive disorder, while Moroccan immigrants showed similar to rather moderately elevated rates. Ethnic discrimination and acculturation were more often related to depressive symptomatology than socio-demographic correlates. Ethnicity seems to be a salient, independent correlate of depression among Turkish and Moroccan immigrant populations in Northwestern Europe.

Medication Adherence to Psychotropic Medication and Relationship with Psychiatric Symptoms among Syrian Refugees in Turkey: A Pilot Study

Background: Due to experiencing traumatic and stressful events, refugees are at risk of having mental disorders. The refugees might need to use psychotropic agents to treat mental disorders. It is essential to understand this population’s adherence rate to psychotropic medication. Aim: This study aimed to evaluate adherence to psychotropic medication and the relationship with psychiatric symptoms among Syrian refugees in Turkey. Method: The study design was descriptive and correlational. The study was conducted with 55 Syrian refugees attending a community health center in southern Turkey. The data was collected with General Medication Adherence Scale–Arabic Version (GMAS–AR) and Brief Psychiatric Inventory (BPI). Results: 78.2% (n: 43) of the participants’ medication adherence was poor, and a significant negative and weak correlation was found at 0.01 level between GMAS–AR and BPI (r: −0.37). According to multiple linear regression analysis, the model with gender and BPI was significant, and this model explained 19% of GMAS–AR total points (p < 0.001). Conclusion: Mental health professionals should test the effectiveness of psychosocial interventions that increase adherence to treatment for the cultural characteristics of societies.

[Utilization of a Specialized Outpatient Service for Parents with Mental Disorders]

BACKGROUND

Patients with mental disorders have a high need for support during the peripartum period. Only few outpatient services have specialized on parents with mental disorders. This study assesses a newly established outpatient unit.

METHODS

We analyzed the population utilizing the outpatient service for parents with psychiatric disorders (N=279) at the psychiatric university hospital of Charité at St. Hedwig-hospital in Berlin, Germany, from June 2017 until December 2021.

RESULTS

The service was mainly utilized by individuals with affective disorders, a higher education and good compliance. Patients with migration background started psychotherapy less often.

DISCUSSION

The data indicate a good acceptance of a specialized outpatient unit for parents with psychiatric disorders; however, it was mainly utilized by individuals with a higher socioeconomic status and less commonly by individuals with severe mental illness. More specialized treatment units for parents would be desirable.

Do Migration and Acculturation Impact Somatization? A Scoping Review

Somatization is a phenomenon in which the individual experiences physical symptoms attributable to mental projections. It is a widely used term in common parlance to figuratively describe a stressful situation. Syndromes directly related to the mind have been described; pathologies are influenced by somatization. However, the extent of somatization is also related to social and cultural factors. In fact, each culture expresses varying levels of somatization characteristic of the country of origin. A disease can even manifest with different symptoms in different ethnic groups. The migration process arises from the need for change on the part of those who undertake it and culminates in the integration of the person in the host country. This process induces changes in the person of a psychological nature, which also affects somatization. In fact, the most integrated subjects show levels of somatization comparable to those of the host country. These considerations support the thesis that psychological changes are an integral part of health and can affect the development of organic and somatized pathologies.