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Mathias K, Bunkley N, Pillai P, Ae-Ngibise KA, Kpobi L, Taylor D, Joag K, Rawat M, Hammoudeh W, Mitwalli S, Kagee A, van Rensburg A, Bemme D, Burgess RA, Jain S, Kienzler H, Read UM. Inverting the deficit model in global mental health: An examination of strengths and assets of community mental health care in Ghana, India, Occupied Palestinian territories, and South Africa. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002575. [PMID: 38437223 PMCID: PMC10911620 DOI: 10.1371/journal.pgph.0002575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 01/08/2024] [Indexed: 03/06/2024]
Abstract
Global mental health [GMH] scholarship and practice has typically focused on the unmet needs and barriers to mental health in communities, developing biomedical and psychosocial interventions for integration into formal health care platforms in response. In this article, we analyse four diverse settings to disrupt the emphasises on health system weaknesses, treatment gaps and barriers which can perpetuate harmful hierarchies and colonial and medical assumptions, or a 'deficit model'. We draw on the experiential knowledge of community mental health practitioners and researchers working in Ghana, India, the Occupied Palestinian Territory and South Africa to describe key assets existing in 'informal' community mental health care systems and how these are shaped by socio-political contexts. These qualitative case studies emerged from an online mutual learning process convened between 39 academic and community-based collaborators working in 24 countries who interrogated key tenets to inform a social paradigm for global mental health. Bringing together diverse expertise gained from professional practice and research, our sub-group explored the role of Community Mental Health Systems in GMH through comparative country case studies describing the features of community care beyond the health and social care system. We found that the socio-political health determinants of global economic structures in all four countries exert significant influence on local community health systems. We identified that key assets across sites included: family and community care, and support from non-profit organisations and religious and faith-based organisations. Strengthening community assets may promote reciprocal relationships between the formal and informal sectors, providing resources for support and training for communities while communities collaborate in the design and delivery of interventions rooted in localised expertise. This paper highlights the value of informal care, the unique social structures of each local context, and resources within local communities as key existing assets for mental health.
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Affiliation(s)
- Kaaren Mathias
- Faculty of Health, University of Canterbury New Zealand, Christchurch New Zealand and Burans, Herbertpur Christian Hospital, Emmanuel Hospital Association, New Delhi, India
| | - Noah Bunkley
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Pooja Pillai
- Burans, Herbertpur Christian Hospital, Emmanuel Hospital Association, New Delhi, India
| | | | - Lily Kpobi
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
| | - Dan Taylor
- Executive Secretary, Mind Freedom, Accra, Ghana
| | - Kaustubh Joag
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Meenal Rawat
- Burans, Herbertpur Christian Hospital, Emmanuel Hospital Association, New Delhi, India
- School of Political and Social Science, University of Edinburgh, Edinburgh, Scotland
| | - Weeam Hammoudeh
- Institute of Community and Public Health, Birzeit University, West Bank, Occupied Palestinian Territories
| | - Suzan Mitwalli
- Institute of Community and Public Health, Birzeit University, West Bank, Occupied Palestinian Territories
| | - Ashraf Kagee
- Stellenbosch University, Stellenbosch, South Africa
| | - Andre van Rensburg
- Centre for Rural Health, University of Kwazulu-Natal, Durban, South Africa
| | - Dörte Bemme
- Centre of Society and Mental health, King’s College London, London, United Kingdom
| | - Rochelle A. Burgess
- Institute for Global Health, University College London, London, United Kingdom
| | - Sumeet Jain
- School of Political and Social Science, University of Edinburgh, Edinburgh, Scotland
| | - Hanna Kienzler
- Department of Global Health and Social Medicine and Centre for Society and Mental Health, King’s College London, London, United Kingdom
| | - Ursula M. Read
- Warwick Medical School, University of Warwick, Warwick, United Kingdom
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Bailie CR, Pillai PS, Goodwin Singh A, Leishman J, Grills NJ, Mathias K. Does the Nae Umeed group intervention improve mental health and social participation? A pre-post study in Uttarakhand, India. Glob Ment Health (Camb) 2023; 10:e47. [PMID: 37854393 PMCID: PMC10579688 DOI: 10.1017/gmh.2023.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/21/2023] [Accepted: 07/19/2023] [Indexed: 10/20/2023] Open
Abstract
There are few evidence-based interventions to support caregiver mental health developed for low- and middle-income countries. Nae Umeed is a community-based group intervention developed with collaboratively with local community health workers in Uttarakhand, India primarily to promote mental wellbeing for caregivers and others. This pre-post study aimed to evaluate whether Nae Umeed improved mental health and social participation for people with mental distress, including caregivers. The intervention consisted of 14 structured group sessions facilitated by community health workers. Among 115 adult participants, 20% were caregivers and 80% were people with disability and other vulnerable community members; 62% had no formal education and 92% were female. Substantial and statistically significant improvements occurred in validated psychometric measures for mental health (12-Item General Health Questionnaire, Patient Health Questionnaire-9) and social participation (Participation Scale). Improvements occurred regardless of caregiver status. This intervention addressed mental health and social participation for marginalised groups that are typically without access to formal mental health care and findings suggest Nae Umeed improved mental health and social participation; however, a controlled community trial would be required to prove causation. Community-based group interventions are a promising approach to improving the mental health of vulnerable groups in South Asia.
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Affiliation(s)
- Christopher R. Bailie
- Nossal Institute for Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Pooja S. Pillai
- Burans, Herbertpur Christian Hospital, Emmanuel Hospital Association, Dehradun, India
| | - Atul Goodwin Singh
- Burans, Herbertpur Christian Hospital, Emmanuel Hospital Association, Dehradun, India
| | - Jed Leishman
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Nathan J. Grills
- Nossal Institute for Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Kaaren Mathias
- Burans, Herbertpur Christian Hospital, Emmanuel Hospital Association, Dehradun, India
- Faculty of Health, University of Canterbury, Christchurch, New Zealand
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Koschorke M, Oexle N, Ouali U, Cherian AV, Deepika V, Mendon GB, Gurung D, Kondratova L, Muller M, Lanfredi M, Lasalvia A, Bodrogi A, Nyulászi A, Tomasini M, El Chammay R, Abi Hana R, Zgueb Y, Nacef F, Heim E, Aeschlimann A, Souraya S, Milenova M, van Ginneken N, Thornicroft G, Kohrt BA. Perspectives of healthcare providers, service users, and family members about mental illness stigma in primary care settings: A multi-site qualitative study of seven countries in Africa, Asia, and Europe. PLoS One 2021; 16:e0258729. [PMID: 34705846 PMCID: PMC8550394 DOI: 10.1371/journal.pone.0258729] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 10/01/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Stigma among healthcare providers is a barrier to the effective delivery of mental health services in primary care. Few studies have been conducted in primary care settings comparing the attitudes of healthcare providers and experiences of people with mental illness who are service users in those facilities. Such research is necessary across diverse global settings to characterize stigma and inform effective stigma reduction. METHODS Qualitative research was conducted on mental illness stigma in primary care settings in one low-income country (Nepal), two lower-middle income countries (India, Tunisia), one upper-middle-income country (Lebanon), and three high-income countries (Czech Republic, Hungary, Italy). Qualitative interviews were conducted with 248 participants: 64 primary care providers, 11 primary care facility managers, 111 people with mental illness, and 60 family members of people with mental illness. Data were analyzed using framework analysis. RESULTS Primary care providers endorsed some willingness to help persons with mental illness but reported not having appropriate training and supervision to deliver mental healthcare. They expressed that people with mental illness are aggressive and unpredictable. Some reported that mental illness is incurable, and mental healthcare is burdensome and leads to burnout. They preferred mental healthcare to be delivered by specialists. Service users did not report high levels of discrimination from primary care providers; however, they had limited expectations of support from primary care providers. Service users reported internalized stigma and discrimination from family and community members. Providers and service users reported unreliable psychiatric medication supply and lack of facilities for confidential consultations. Limitations of the study include conducting qualitative interviews in clinical settings and reliance on clinician-researchers in some sites to conduct interviews, which potentially biases respondents to present attitudes and experiences about primary care services in a positive manner. CONCLUSIONS Primary care providers' willingness to interact with people with mental illness and receive more training presents an opportunity to address stigmatizing beliefs and stereotypes. This study also raises important methodological questions about the most appropriate strategies to accurately understand attitudes and experiences of people with mental illness. Recommendations are provided for future qualitative research about stigma, such as qualitative interviewing by non-clinical personnel, involving non-clinical staff for recruitment of participants, conducting interviews in non-clinical settings, and partnering with people with mental illness to facilitate qualitative data collection and analysis.
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Affiliation(s)
- Mirja Koschorke
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Nathalie Oexle
- Department for Psychiatry II, Ulm University and BKH Günzburg, Günzburg, Germany
| | - Uta Ouali
- Department of Psychiatry A, Razi Hospital La Manouba, Manouba, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Anish V. Cherian
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Vayankarappadam Deepika
- Department of Epidemiology, Centre for Public Health, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Gurucharan Bhaskar Mendon
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Dristy Gurung
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Lucie Kondratova
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czechia
| | - Matyas Muller
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czechia
| | - Mariangela Lanfredi
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Antonio Lasalvia
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | | | - Mario Tomasini
- Department of Mental Health, Alto Garda e Ledro Giudicarie, Arco, Italy
| | - Rabih El Chammay
- National Mental Health Programme Ministry of Public Health, Beirut, Lebanon
- Department of Psychiatry, Saint Joseph University, Beirut, Lebanon
| | - Racha Abi Hana
- National Mental Health Programme Ministry of Public Health, Beirut, Lebanon
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, The Netherlands
| | - Yosra Zgueb
- Department of Psychiatry A, Razi Hospital La Manouba, Manouba, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Fethi Nacef
- Department of Psychiatry A, Razi Hospital La Manouba, Manouba, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Eva Heim
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | | | | | - Maria Milenova
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Nadja van Ginneken
- Institute of Population Health Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Graham Thornicroft
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Brandon A. Kohrt
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
- Division of Global Mental Health, Department of Psychiatry, George Washington University, Washington, DC, United States of America
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Mathias K, Rawat M, Philip S, Grills N. "We've got through hard times before: acute mental distress and coping among disadvantaged groups during COVID-19 lockdown in North India - a qualitative study". Int J Equity Health 2020; 19:224. [PMID: 33334344 PMCID: PMC7745174 DOI: 10.1186/s12939-020-01345-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 12/07/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The COVID-19 crisis in India negatively impacted mental health due to both the disease and the harsh lockdown, yet there are almost no qualitative studies describing mental health impacts or the strategies of resilience used, and in particular, no reports from the most vulnerable groups. This study aimed to examine the acute mental health impacts of the COVID-19 crisis as well as coping strategies employed by disadvantaged community members in North India. METHODS We used an intersectional lens for this qualitative study set in rural Tehri Garwhal and urban Dehradun districts of Uttarakhand, India. In-depth interviews were conducted in May 2020 during lockdown, by phone and in person using purposive selection, with people with disabilities, people living in slums with psychosocial disabilities and widows (total n = 24). We used the framework method for analysis following steps of transcription and translation, familiarisation, coding, developing and then applying a framework, charting and then interpreting data. FINDINGS The participants with compounded disadvantage had almost no access to mobile phones, health messaging or health care and experienced extreme mental distress and despair, alongside hunger and loss of income. Under the realms of intrapersonal, interpersonal and social, six themes related to mental distress emerged: feeling overwhelmed and bewildered, feeling distressed and despairing, feeling socially isolated, increased events of othering and discrimination, and experiencing intersectional disadvantage. The six themes summarising coping strategies in the COVID-19 crisis were: finding sense and meaning, connecting with others, looking for positive ways forward, innovating with new practices, supporting others individually and collectively, and engaging with the natural world. CONCLUSIONS People intersectionally disadvantaged by their social identity experienced high levels of mental distress during the COVID-19 crisis, yet did not collapse, and instead described diverse and innovative strategies which enabled them to cope through the COVID-19 lockdown. This study illustrates that research using an intersectional lens is valuable to design equitable policy such as the need for access to digital resources, and that disaggregated data is needed to address social inequities at the intersection of poverty, disability, caste, religious discrimination and gender inherent in the COVID-19 pandemic in India.
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Affiliation(s)
- Kaaren Mathias
- Burans, Herbertpur Christian Hospital, Attenbagh, Herbertpur, Uttarakhand, India.
| | - Meenal Rawat
- Burans, Herbertpur Christian Hospital, Attenbagh, Herbertpur, Uttarakhand, India
| | - Sharad Philip
- Psychiatric Rehabilitation Department, NIMHANS, Bengaluru, India
| | - Nathan Grills
- Nossal Institute, University of Melbourne and Australia- India Institute, Melbourne, Australia
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Shi J, Tang L, Jing L, Geng J, Liu R, Luo L, Chen N, Liu Q, Gong X, Bo X, Yang Y, Wang Z. Disparities in mental health care utilization among inpatients in various types of health institutions: a cross-sectional study based on EHR data in Shanghai, China. BMC Public Health 2019; 19:1023. [PMID: 31366334 PMCID: PMC6668074 DOI: 10.1186/s12889-019-7343-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 07/19/2019] [Indexed: 01/24/2023] Open
Abstract
Background Reform of the health care system in China has prompted concerns about the utilization of mental health services. This study aims to compare the utilization of mental health services among inpatients in various types of health institutions in Shanghai (community health care centres, secondary general hospitals, tertiary general hospitals, and specialty hospitals). Methods Based on electronic health record (EHR) data, we extracted all of the mental hospitalization data from various types of public health institutions in Pudong New Area, Shanghai, China, from 2013 to 2016. The distribution of mentally ill inpatients and the possible factors contributing to the observed differences in these institutions were analysed. Results Specialty psychiatric hospitals in Pudong New Area, Shanghai, admitted more inpatients and treated in patients with more severe disorders (49.73%). However, those who were male (OR = 0.545), were elderly (OR = 20.133), had inferior insurance (urban social insurance for citizens: OR = 4.013; paying themselves, OR = 29.489), had a longer length of stay (OR = 1.001) and had lower costs (OR = 0.910) were more likely to choose community health centres than specialty hospitals. Those who preferred the secondary and tertiary hospitals to the specialty ones were more likely to be in the male, elderly, married, shorter length of stay and higher-cost groups. Notably, compared to those with urban social insurance for workers, those who had urban social insurance for citizens (OR = 3.136) or paid out-of-pocket (OR = 9.822) were significantly clustered in the tertiary hospitals rather than the specialty hospitals. Conclusions Inpatients who were male, were older, had inferior insurance, had a longer length of stay and had lower costs preferred the elementary health services. However, the utilization of mental health care in high-tier institutions reflected defects, especially the fact that the current health insurance system does not adequately restrict patients’ choices, and those who paid more tended to choose tertiary hospitals instead of professional specialty ones. We suggest that psychiatric services should be enhanced by instituting reforms, including public education, improved health insurance, a forceful referral system, and competency reinforcement for primary care physicians, to provide a more integrated mental health system.
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Affiliation(s)
- Jianwei Shi
- School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China.,Yangpu Hospital, Tongji University School of Medicine, Shanghai, 200090, China
| | - Lan Tang
- Pudong Weifang Community Health Center, Shanghai, 200120, China
| | - Limei Jing
- Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Jinsong Geng
- Department of Medical Informatics, Evidence-based Medical Center, Medical School of Nantong University, Nantong, 226001, China
| | - Rui Liu
- Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Li Luo
- School of Public Health, Fudan University, Shanghai, 200032, China
| | - Ning Chen
- School of Medicine, Tongji University, Shanghai, 200092, China
| | - Qian Liu
- School of Economics and Management, Tongji University, Shanghai, 200092, China
| | - Xin Gong
- School of Medicine, Tongji University, Shanghai, 200092, China
| | - Xiaojie Bo
- School of Medicine, Tongji University, Shanghai, 200092, China
| | - Yan Yang
- School of Economics and Management, Tongji University, Shanghai, 200092, China
| | - Zhaoxin Wang
- School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China. .,General Practice Center, Nanhai Hospital, Southern Medical University, 227 Chongqing South RD, Shanghai, 200025, 528244, Guangdong, China.
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Hall T, Kakuma R, Palmer L, Minas H, Martins J, Kermode M. Social inclusion and exclusion of people with mental illness in Timor-Leste: a qualitative investigation with multiple stakeholders. BMC Public Health 2019; 19:702. [PMID: 31174504 PMCID: PMC6554932 DOI: 10.1186/s12889-019-7042-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Social inclusion is a human right for all people, including people with mental illness. It is also an important part of recovery from mental illness. In Timor-Leste, no research has investigated the social experiences of people with mental illness and their families. To fill this knowledge gap and inform ongoing mental health system strengthening, we investigated the experiences of social inclusion and exclusion of people with mental illness and their families in Timor-Leste. METHODS Eighty-five participants from the following stakeholder groups across multiple locations in Timor-Leste were interviewed: (1) people with mental illness and their families; (2) mental health and social service providers; (3) government decision makers; (4) civil society members; and (5) other community members. Framework analysis was used to analyse interview transcripts. RESULTS People with mental illness in Timor-Leste were found to face widespread, multi-faceted sociocultural, economic and political exclusion. People with mental illness were stigmatised as a consequence of beliefs that they were dangerous and lacked capacity, and experienced instances of bullying, physical and sexual violence, and confinement. Several barriers to formal employment, educational, social protection and legal systems were identified. Experiences of social inclusion for people with mental illness were also described at family and community levels. People with mental illness were included through family and community structures that promoted unity and acceptance. They also had opportunities to participate in activities surrounding family life and livelihoods that contributed to intergenerational well-being. Some, but not all, Timorese people with mental illness benefited from disability-inclusive programming and policies, including the disability pension, training programs and peer support. CONCLUSIONS These findings highlight the need to combat social exclusion of people with mental illness and their families by harnessing local Timorese sociocultural strengths. Such an approach could centre around people with mental illness and their families to: increase population mental health awareness; bolster rights-based and culturally-grounded mental health services; and promote inclusive and accessible services and systems across sectors.
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Affiliation(s)
- Teresa Hall
- Nossal Institute for Global Health, University of Melbourne, 333 Exhibition St, Melbourne, Victoria, 3004, Australia.
| | - Ritsuko Kakuma
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK
- Centre for Mental Health, University of Melbourne, Melbourne, Australia
| | - Lisa Palmer
- School of Geography, University of Melbourne, Melbourne, Australia
| | - Harry Minas
- Centre for Mental Health, University of Melbourne, Melbourne, Australia
| | - João Martins
- Faculty of Medicine and Health Sciences, National University of Timor-Leste, Díli, Timor-Leste
| | - Michelle Kermode
- Nossal Institute for Global Health, University of Melbourne, 333 Exhibition St, Melbourne, Victoria, 3004, Australia
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Mathias K, Singh P, Butcher N, Grills N, Srinivasan V, Kermode M. Promoting social inclusion for young people affected by psycho-social disability in India - a realist evaluation of a pilot intervention. Glob Public Health 2019; 14:1718-1732. [PMID: 31094290 DOI: 10.1080/17441692.2019.1616798] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
India has 600 million young people, more than any other country in the world. Mental illness is the leading burden of disease for young people, and those affected experience restrictions in social participation that compromise recovery. The aim of this study was to assess the impact of a peer-led, community-based, participatory group intervention on social inclusion and mental health among 142 young people affected by psycho-social disability (PSD) in Dehradun district, Uttarakhand. Qualitative data were obtained via in-depth interviews and focus-group discussions. A realist evaluation identified contextual factors, mechanisms and outcomes to develop the programme theory. Group participants described intermediate outcomes including establishment of new peer friendship networks, increased community participation, greater self-efficacy (for young women particularly), and improved public image (for young men) that are likely to have contributed to the primary outcomes of greater (self-perceived) social inclusion and improved mental health (as assessed quantitatively). Mechanisms were identified that explain the link between intervention and outcomes. These findings demonstrate the effectiveness of a brief intervention to improve mental health and social inclusion for young people with PSD and are potentially relevant to programme implementers and policy-makers working with young people and promoting social inclusion, in other low- and middle-income settings.
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Affiliation(s)
| | | | - Nicole Butcher
- Nossal Institute for Global Health, University of Melbourne , Melbourne VIC, Australia
| | - Nathan Grills
- Nossal Institute for Global Health, University of Melbourne , Melbourne VIC, Australia
| | | | - Michelle Kermode
- Nossal Institute for Global Health, University of Melbourne , Melbourne VIC, Australia
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Tanaka C, Tuliao MTR, Tanaka E, Yamashita T, Matsuo H. A qualitative study on the stigma experienced by people with mental health problems and epilepsy in the Philippines. BMC Psychiatry 2018; 18:325. [PMID: 30290782 PMCID: PMC6173886 DOI: 10.1186/s12888-018-1902-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 09/20/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Stigma towards people with mental health problems (PMHP) is known to have substantial negative impacts on their lives. More in-depth exploration of the stigma and discrimination experienced by PMHP in low- and middle-income countries is needed. Previous research suggests that negative attitudes towards PMHP are widespread among the Filipino general public. However, no study has investigated PMHP's own experiences of being stigmatised in the Philippines. METHODS A qualitative study was conducted on the stigma experienced by PMHP (including people with epilepsy) and its related factors in the Philippines, employing the constructivist grounded theory approach. We analysed data on 39 PMHP collected through interviews with PMHP, their carers, and community health volunteers who know them well. RESULTS The findings highlight the culturally and socio-economically specific contexts, consequences, and impact modifiers of experiences of stigma. Participants emphasised that PMHP face stigma because of the cultural traits such as the perception of mental health problem as a disease of the family and the tendency to be overly optimistic about the severity of the mental health problem and its impact on their life. Further, stigma was experienced under conditions where mental health care was not readily available and people in the local community could not resolve the PMHP's mental health crisis. Stigma experiences reduced social networks and opportunities for PMHP, threatened the economic survival of their entire family, and exacerbated their mental health problems. An individual's reaction to negative experiences can be fatalistic in nature (e.g. believing in it is God's will). This fatalism can help PMHP to remain hopeful. In addition, traditional communal unity alleviated some of the social exclusion associated with stigma. CONCLUSIONS The study indicates that existing stigma-reduction strategies might have limitations in their effectiveness across cultural settings. Therefore, we propose context-specific practical implications (e.g. emphasis on environmental factors as a cause of mental health problems, messages to increase understanding not only of the possibility of recovery but also of challenges PMHP face) for the Philippines.
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Affiliation(s)
- Chika Tanaka
- Graduate School of Health Sciences, Kobe University, 701, 2-6-2, Yamamoto-dori, Chuo-ku, Kobe, Hyogo, 650-0003, Japan.
| | | | - Eizaburo Tanaka
- 0000 0004 0466 6360grid.474282.fHyogo Institute for Traumatic Stress, Kobe, Japan
| | | | - Hiroya Matsuo
- 0000 0001 1092 3077grid.31432.37Graduate School of Health Sciences, Kobe University, 701, 2-6-2, Yamamoto-dori, Chuo-ku, Kobe, Hyogo 650-0003 Japan
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Imkome EU, Waraassawapati K. Perspectives and Experiences of Primary Caregivers of Individuals with Schizophrenia in Thailand. Issues Ment Health Nurs 2018; 39:858-864. [PMID: 30252542 DOI: 10.1080/01612840.2018.1488312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study investigates primary caregiver perspectives on long-term experiences of caring for individuals with schizophrenia in Thailand. Study participants were 30 caregivers in the Bangkok Metropolitan Area (BMA). Data were collected by semi-structured qualitative interview and analyzed by thematic analysis. Participants defined psychotic symptoms as symptoms requiring prevention and good care, which caregivers must learn to live with. Caregivers were reported to have "acquired experience in controlling psychotic symptoms and recognizing frequency, timing, content, warning signs, and patient response." Schizophrenic patients experienced difficulty engaging in community activities and encountered teasing, stigma, and social isolation. These findings suggest that caregivers saw psychotic symptoms as necessarily leading to ongoing serious problems. The difficulty of dealing with such symptoms was aggravated by caregiver poverty, emotional condition, and advanced age. Innovations in psychiatric and mental health nursing intervention are needed, including psycho-educational community activities to confront the teasing, stigma, and social isolation of individuals with schizophrenia. Simulation applications on mobile phones and Internet are recommended.
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Affiliation(s)
- Ek-Uma Imkome
- a Faculty of Nursing , Thammasat University , Klong-luang , Patumtanee , Thailand
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Greenwood N, Mezey G, Smith R. Social exclusion in adult informal carers: A systematic narrative review of the experiences of informal carers of people with dementia and mental illness. Maturitas 2018; 112:39-45. [DOI: 10.1016/j.maturitas.2018.03.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 03/25/2018] [Accepted: 03/28/2018] [Indexed: 11/16/2022]
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11
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Mathias K, Kermode M, Goicolea I, Seefeldt L, Shidhaye R, San Sebastian M. Social Distance and Community Attitudes Towards People with Psycho-Social Disabilities in Uttarakhand, India. Community Ment Health J 2018; 54:343-353. [PMID: 29143156 DOI: 10.1007/s10597-017-0211-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 11/06/2017] [Indexed: 11/28/2022]
Abstract
Stigma is an important contributor to the large treatment gap for people with mental and psycho-social disabilities (PPSD) in India. Social distance as assessed by willingness to engage in relationships with PPSD is a proxy measure of stigma and potential discrimination. In North India, investigations of community attitudes towards PPSD have been limited. To describe attitudes towards people with depression and psychosis, a community sample of 960 adults in Dehradun district, India from 30 randomised clusters, was surveyed using a validated tool to assess social distance, beliefs and attitudes related to mental illness. Participants preferred greater social distance from a person with psychosis than a person with depression. Beliefs and attitudes around mental illness were diverse reflecting a wide spread of belief frameworks. After controlling for confounding, there was increased social distance among people who believed PPSD were dangerous. Factors that reduced social distance included familiarity with PPSD, and belief that PPSD can recover. Attitudes to PPSD, stigma and social distance are complex and likely to require complex responses that include promoting awareness of mental health and illness, direct contact with PPSD and increasing access to care for PPSD.
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Affiliation(s)
- K Mathias
- Emmanuel Hospital Association, New Delhi, India. .,Department of Epidemiology and Global Health, Umea University, Förvaltningshuset, Universitetstorget 16, 901 87, Umeå, Sweden. .,Landour community hospital, Mussoorie, Uttarakhand, 248 179, India.
| | - M Kermode
- Nossal Institute of Global Health, University of Melbourne, 161 Barry Street, Melbourne, Australia
| | - I Goicolea
- Department of Epidemiology and Global Health, Umea University, Förvaltningshuset, Universitetstorget 16, 901 87, Umeå, Sweden
| | - L Seefeldt
- Woodstock School, Upper Tehri Road, Mussoorie, Uttarakhand, 248 179, India
| | - R Shidhaye
- Public Health Foundation of India, Delhi NCR, Plot No. 47, Sector 44, Institutional Area Gurgaon, New Delhi, 122002, India
| | - M San Sebastian
- Department of Epidemiology and Global Health, Umea University, Förvaltningshuset, Universitetstorget 16, 901 87, Umeå, Sweden
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Islam MM, Jahan N, Hossain MD. Violence against women and mental disorder: a qualitative study in Bangladesh. Trop Med Health 2018; 46:5. [PMID: 29507506 PMCID: PMC5831218 DOI: 10.1186/s41182-018-0085-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 01/25/2018] [Indexed: 11/10/2022] Open
Abstract
Background Violence affects 15-75% of women across the globe and has a significant impact on their health, well-being, and rights. While quantitative research links it to poor mental health, there is a lack of qualitative enquiry in how women experience it, and how it is related to the mental disorders in Bangladesh. This information is important in understanding the situation and structuring a locally appropriate and culturally sensitive program. Methods We adopted a phenomenological approach and conducted 16 in-depth interviews, three informal interviews, one focus group discussion, and one key informant interview. We also reviewed published reports and documents. We followed criterion sampling in selecting women with mental disorders who experienced violence. We explored their experiences and understanding of the issues and described the phenomenon. Results We found that Bangladesh society was largely controlled by men, and marriage was often forced on women. Women often were blamed for any mishap in the family and married women were under social and emotional pressure to keep the marital relationship going even when painful. We found all forms of violence (physical, emotional, sexual etc.) and most of the time found more than one type in women with mental disorders. Sexual violence is a reality for some women but rarely discussed. We found the society very tolerant with mental disorder patients and those who resorted to violence against them.We identified four theoretical understandings about the role of violence in mental disorders. Sometimes the violence predisposed the mental illness, sometimes it precipitated it, while other times it maintained and was a consequence of it. Sometimes the violence may be unrelated to the mental illness. The relationships were complex and depended on both the type of mental disorder and the nature and intensity of the violence. We found most of the time that more than one type of violence was involved and played more than one role, which varied across different types of mental disorders. Interestingly, not all violence that mentally disordered women faced was because they were women, but because of mental disorders, which brought violence to them as a consequence. Conclusions The findings of this first ever qualitative study into the experiences of violence by women with mental disorder in Bangladesh can be used in developing a culturally specific intervention to reduce both violence and mental disorders in women.
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Affiliation(s)
- Md Manirul Islam
- 1Training Unit, icddr,b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Nasim Jahan
- 2Department of Psychiatry, BIRDEM General Hospital and IMC, Dhaka, Bangladesh
| | - Md Delwar Hossain
- National Institute of Mental Health, Sher-e-bangla Nagar, Dhaka, 1207 Bangladesh
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Mathias K, Pant H, Marella M, Singh L, Murthy GVS, Grills N. Multiple barriers to participation for people with psychosocial disability in Dehradun district, North India: a cross-sectional study. BMJ Open 2018; 8:e019443. [PMID: 29487074 PMCID: PMC5855246 DOI: 10.1136/bmjopen-2017-019443] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES This study used a population-based cross-sectional survey to describe the prevalence of psychosocial disability and unmet need for access to services in North India. SETTING This study was conducted in Dehradun district, Uttarakhand, in 2014. PARTICIPANTS A population-based sample of 2441 people over the age of 18 years. PRIMARY OUTCOME MEASURES The Rapid Assessment of Disability survey tool identified people with disability and used an adapted version of the Kessler scale to identify those with psychosocial disability. It additionally collected information on socioeconomic variables, access to community services and barriers to participation. Prevalence of psychosocial disability and unmet needs and descriptions of barriers to services were calculated, and multivariable logistic regression was used to assess associations between risk factors and psychosocial disability. RESULTS Prevalence of psychosocial disability was 4.8% and 75% of participants with psychological distress also reported comorbid functional impairments. Adjusted ORs for depression of more than two were found for people who were unschooled, unemployed and of moderate or poor socioeconomic status. The unmet need for access to services was significantly higher in every domain for people with psychosocial disability and was more than 25% in the areas of employment, health service access and community consultation. People with psychosocial disability encountered greater barriers in each domain compared with controls. CONCLUSIONS People who are poor, uneducated and unemployed are two to four times more likely to have psychosocial disability in Dehradun district. They face unmet needs in accessing community services and perceive negative social attitudes, lack of physical accessibility and lack of information as barriers limiting their participation. Social policy must increase access to education and reduce poverty but additionally ensure action is taken in all community services to increase information, physical accessibility and social inclusion of people with psychosocial and other forms of disability.
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Affiliation(s)
- Kaaren Mathias
- Landour Community Hospital, Mussoorie, Uttarakhand, India
| | - Hira Pant
- Public Health Foundation of India, Indian Institute of Public Health, Hyderabad, Telangana, India
| | - Manju Marella
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | | | - GVS Murthy
- Public Health Foundation of India, Indian Institute of Public Health, Hyderabad, Telangana, India
| | - Nathan Grills
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Murray SM, Augustinavicius J, Kaysen D, Rao D, Murray LK, Wachter K, Annan J, Falb K, Bolton P, Bass JK. The impact of Cognitive Processing Therapy on stigma among survivors of sexual violence in eastern Democratic Republic of Congo: results from a cluster randomized controlled trial. Confl Health 2018; 12:1. [PMID: 29449879 PMCID: PMC5808396 DOI: 10.1186/s13031-018-0142-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 01/12/2018] [Indexed: 12/02/2022] Open
Abstract
Background Sexual violence is associated with a multitude of poor physical, emotional, and social outcomes. Despite reports of stigma by sexual violence survivors, limited evidence exists on effective strategies to reduce stigma, particularly in conflict-affected settings. We sought to assess the effect of group Cognitive Processing Therapy (CPT) on stigma and the extent to which stigma might moderate the effectiveness of CPT in treating mental health problems among survivors of sexual violence in the Democratic Republic of Congo. Methods Data were drawn from 405 adult female survivors of sexual violence reporting mental distress and poor functioning in North and South Kivu. Women were recruited through organizations providing psychosocial support and then cluster randomized to group CPT or individual support. Women were assessed at baseline, the end of treatment, and again six months later. Assessors were masked to women’s treatment assignment. Linear mixed-effect regression models were used to estimate (1) the effect of CPT on feelings of perceived and internalized (felt) stigma, and (2) whether felt stigma and discrimination (enacted stigma) moderated the effects of CPT on combined depression and anxiety symptoms, posttraumatic stress, and functional impairment. Results Participants receiving CPT experienced moderate reductions in felt stigma relative to those in individual support (Cohen’s D = 0.44, p = value = 0.02) following the end of treatment, though this difference was no longer significant six-months later (Cohen’s D = 0.45, p = value = 0.12). Neither felt nor enacted stigma significantly moderated the effect of CPT on mental health symptoms or functional impairment. Conclusions Group cognitive-behavioral based therapies may be an effective stigma reduction tool for survivors of sexual violence. Experiences and perceptions of stigma did not hinder therapeutic effects of group psychotherapy on survivors’ mental health. Trial registration ClinicalTrials.gov NCT01385163. Electronic supplementary material The online version of this article (10.1186/s13031-018-0142-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S M Murray
- 1Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 624 N Broadway Street, Baltimore, MD 21205 USA
| | - J Augustinavicius
- 1Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 624 N Broadway Street, Baltimore, MD 21205 USA
| | - D Kaysen
- 2Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA USA
| | - D Rao
- 2Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA USA.,3Department of Global Health, University of Washington, Seattle, WA USA
| | - L K Murray
- 1Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 624 N Broadway Street, Baltimore, MD 21205 USA
| | - K Wachter
- 4University of Texas, School of Social Work, Austin, TX USA
| | - J Annan
- 5Research, Evaluation and Learning Unit, International Rescue Committee, New York, NY USA.,6Harris School of Public Policy, University of Chicago, Chicago, USA
| | - K Falb
- 5Research, Evaluation and Learning Unit, International Rescue Committee, New York, NY USA
| | - P Bolton
- 1Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 624 N Broadway Street, Baltimore, MD 21205 USA.,7Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD USA
| | - J K Bass
- 1Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 624 N Broadway Street, Baltimore, MD 21205 USA
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Mathias K, Mathias J, Goicolea I, Kermode M. Strengthening community mental health competence-A realist informed case study from Dehradun, North India. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:e179-e190. [PMID: 28891109 DOI: 10.1111/hsc.12498] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/29/2017] [Indexed: 06/07/2023]
Abstract
Few accounts exist of programmes in low- and middle-income countries seeking to strengthen community knowledge and skills in mental health. This case study uses a realist lens to explore how a mental health project in a context with few mental health services, strengthened community mental health competence by increasing community knowledge, creating safer social spaces and engaging partnerships for action. We used predominantly qualitative methods to explore relationships between context, interventions, mechanisms and outcomes in the "natural setting" of a community-based mental health project in Dehradun district, Uttarakhand, North India. Qualitative data came from focus group discussions, participant observation and document reviews of community teams' monthly reports on changes in behaviour, attitudes and relationships among stakeholder groups. Data analysis initially involved thematic analysis of three domains: knowledge, safe social spaces and partnerships for action. By exploring patterns within the identified themes for each domain, we were able to infer the mechanisms and contextual elements contributing to observed outcomes. Community knowledge was effectively increased by allowing communities to absorb new understanding into pre-existing social and cultural constructs. Non-hierarchical informal community conversations allowed "organic" integration of unfamiliar biomedical knowledge into local explanatory frameworks. People with psycho-social disability and caregivers found increased social support and inclusion by participating in groups. Building skills in respectful communication through role plays and reflexive discussion increased the receptivity of social environments to people with psycho-social disabilities participation, thereby creating safe social spaces. Facilitating social networks through groups increases women's capacity for collective action to promote mental health. In summary, locally appropriate methods contribute most to learning, stigma reduction and help-seeking. The complex social change progress was patchy and often slow. This study demonstrates a participatory, iterative, reflexive project design which is generating evidence indicating substantial improvements in community mental health competence.
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Affiliation(s)
- Kaaren Mathias
- Department of Community Health and Development, Emmanuel Hospital Association, New Delhi, India
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Jeph Mathias
- Independent Consultant, Mussoorie, Uttarakhand, India
| | - Isabel Goicolea
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Michelle Kermode
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Daniel M, Njau B, Mtuya C, Okelo E, Mushi D. Perceptions of Mental Disorders and Help-Seeking Behaviour for Mental Health Care Within the Maasai Community of Northern Tanzania: An Exploratory Qualitative Study. East Afr Health Res J 2018; 2:103-111. [PMID: 34308180 PMCID: PMC8279158 DOI: 10.24248/eahrj-d-18-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 08/30/2018] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Mental disorders are rapidly becoming more prevalent worldwide and are estimated to contribute up to 15% of the global burden of disease by 2020. In Africa, the help-seeking behaviour for mental health care is complex and is hindered by misconceptions and negative attitudes towards mental disorders. This study aimed to explore perceptions of mental disorders and help-seeking behaviour for mental health care within the Maasai community in northern Tanzania. METHODS This qualitative study enrolled a purposive sample of 41 participants from a Maasai community in Arusha Region, northern Tanzania. Participants included modern health-care providers, religious leaders, traditional practitioners, local government leaders, local Maasai leaders, and workers from nongovernmental organisations dealing with mental health. Local interviewers used interview guides to conduct in-depth interviews and focus group discussions in the local language, Kiswahili. The interviews were completed between April and May 2013. We used content analysis to analyse the qualitative data. RESULTS Study participants attributed mental disorders to supernatural causes, such as curses, witchcraft, demons, and God's will. A few participants also mentioned biological causes and risk behaviours, including perinatal insults, head injuries, and drug abuse. Furthermore, we found that the Maasai community seeks mental health care in a sequential and simultaneous manner from 3 sectors, namely, professional health-care providers, traditional healers, and religious leaders. Traditional healers and religious leaders were preferred over professional health-care providers for the treatment of mental disorders. CONCLUSION The Maasai have pluralistic help-seeking behaviour for mental health disorders. Integrating traditional healers in the modern health-care system may be beneficial to addressing mental health issues in this setting.
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Affiliation(s)
- Monica Daniel
- Department of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Bernard Njau
- Department of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania,Correspondence to Bernard Njau ()
| | - Chauka Mtuya
- Department of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Elialilia Okelo
- Department of Psychiatry, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Declare Mushi
- Department of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
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17
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Vedana KGG, Silva DRA, Miasso AI, Zanetti ACG, Borges TL. The Meaning of Stigma for People with Mental Disorders in Brazil. Issues Ment Health Nurs 2017; 38:1022-1029. [PMID: 28745917 DOI: 10.1080/01612840.2017.1346013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To understand the meaning of stigma for people with mental disorders. METHOD A qualitative study with 46 Brazilian adults with mental disorders. Data were collected through semistructured interviews and nonparticipant observation and submitted for a thematic analysis with symbolic interactionism. RESULTS Stigma was considered as an experience of incomprehension and suffering. The society has difficulty in empathizing, respecting differences and understanding the extent of the suffering of people with mental disorders. Participants recommended anti-stigma strategies that included promoting knowledge and respecting differences. CONCLUSIONS The present study contributes new insights to be addressed in interventions to reduce the suffering and impact of stigma.
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Rekhis M, Ben Hamouda A, Ouanes S, Rafrafi R. Rights of people with mental disorders: Realities in healthcare facilities in Tunisia. Int J Soc Psychiatry 2017; 63:439-447. [PMID: 28701086 DOI: 10.1177/0020764017712301] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Mental disorders have been associated worldwide with human rights' violations. Controversially, many occur in mental health facilities. AIM This work aimed to assess the rights of people with mental disorders in healthcare facilities in Tunisia. METHODS A cross-sectional study, using the World Health Organization (WHO) quality-rights toolkit, assessed the human rights levels of achievement in Elrazi Hospital, the only psychiatric hospital in Tunisia, in comparison with the National Institute of Nutrition (NIN). The framework was the Convention on the Rights of Persons with Disabilities (CRPD). The assessment was carried through observation, documentation review, and interviews with service users, staff, and family members. The sample was composed of 113 interviewees. RESULTS In Elrazi Hospital, three out of the five evaluated rights were assessed as only initiated: the right to an adequate standard of living, to exercise legal capacity and to be free from inhuman treatment. By comparison, these rights were partially achieved in the NIN. The right to enjoyment of the highest attainable standard of health was partially achieved and the right to live independently and to be included in the community was not even initiated. These last two rights were at the same level of achievement in the NIN. CONCLUSION Significant improvements are needed to adapt the practice in Elrazi Hospital to comply with human rights, especially since the achievement level of these rights is lower than in a non-psychiatric hospital. Our study emphasizes the importance of spreading the CRPD as a standardized framework.
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Affiliation(s)
- Mayssa Rekhis
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Abir Ben Hamouda
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Sami Ouanes
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Rym Rafrafi
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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Al-Alawi M, Al-Sinawi H, Al-Adawi S, Jeyaseelan L, Murthi S. Public perception of mental illness in Oman: a cross sectional study. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/17542863.2017.1325916] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Mohammed Al-Alawi
- Department of Behavioral Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Hamed Al-Sinawi
- Department of Behavioral Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Samir Al-Adawi
- Department of Behavioral Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Lakshmanan Jeyaseelan
- Department of Statistics and Health Information, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
| | - Sathiya Murthi
- Department of Studies and Research, Oman Medical Specialty Board, Muscat, Sultanate of Oman
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A carer burden and stigma in schizophrenia and affective disorders: Experiences from Sri Lanka. Asian J Psychiatr 2017; 26:77-81. [PMID: 28483097 DOI: 10.1016/j.ajp.2017.01.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 12/07/2016] [Accepted: 01/17/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Stigma compounds the burden experienced by family members of those with a mental illness. This study aimed to examine burden experienced by carers of people with schizophrenia or affective disorders and to explore the relationship between carer burden and stigma. METHOD A cross sectional descriptive study was conducted with patient-carer dyads involving 67 patients diagnosed with schizophrenia and 51 diagnosed with affective disorder. Carers completed the Zarit Burden Interview (short version) and stigma was measured using the Stigma Scale and the Internalised Stigma of Mental Illness Scale. RESULTS Carer burden was significantly higher for schizophrenia than affective disorders. Female carers experienced significantly higher burden than male carers. Diagnosis, gender of carer and stigma predicted 22% of the variance in carer burden, with gender identified as a significant predictor. CONCLUSIONS Reducing stigma related to disclosure of mental illness in carers has the potential to reduce carer burden.
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Experiences of stigma and discrimination faced by family caregivers of people with schizophrenia in India. Soc Sci Med 2017; 178:66-77. [PMID: 28213300 PMCID: PMC5360174 DOI: 10.1016/j.socscimed.2017.01.061] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 01/28/2017] [Accepted: 01/30/2017] [Indexed: 02/07/2023]
Abstract
Stigma associated with schizophrenia significantly affects family caregivers, yet few studies have examined the nature and determinants of family stigma and its relationship to their knowledge about the condition. This paper describes the experiences and determinants of stigma reported by the primary caregivers of people living with schizophrenia (PLS) in India. The study used mixed methods and was nested in a randomised controlled trial of community care for people with schizophrenia. Between November 2009 and October 2010, data on caregiver stigma and functional outcomes were collected from a sample of 282 PLS–caregiver dyads. In addition, 36 in-depth-interviews were conducted with caregivers. Quantitative findings indicate that ‘high caregiver stigma’ was reported by a significant minority of caregivers (21%) and that many felt uncomfortable to disclose their family member's condition (45%). Caregiver stigma was independently associated with higher levels of positive symptoms of schizophrenia, higher levels of disability, younger PLS age, household education at secondary school level and research site. Knowledge about schizophrenia was not associated with caregiver stigma. Qualitative data illustrate the various ways in which stigma affected the lives of family caregivers and reveal relevant links between caregiver-stigma related themes (‘others finding out’, ‘negative reactions’ and ‘negative feelings and views about the self’) and other themes in the data. Findings highlight the need for interventions that address both the needs of PLS and their family caregivers. Qualitative data also illustrate the complexities surrounding the relationship between knowledge and stigma and suggest that providing ‘knowledge about schizophrenia’ may influence the process of stigmatisation in both positive and negative ways. We posit that educational interventions need to consider context-specific factors when choosing anti-stigma-messages to be conveyed. Our findings suggest that messages such as ‘recovery is possible’ and ‘no-one is to blame’ may be more helpful than focusing on bio-medical knowledge alone. Experiences of being blamed and worries about marital prospects were salient. Caregivers' and PLS' experiences of stigma were determined by similar factors. Knowledge was linked to stigma in qualitative but not in quantitative analyses. Context-specific messages rather than biomedical knowledge may help reduce stigma. Family caregivers need access to emotional and social support in their own right.
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Diagnosed but Not Undiagnosed Diabetes Is Associated with Depression in Rural Areas. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13111136. [PMID: 27854262 PMCID: PMC5129346 DOI: 10.3390/ijerph13111136] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 11/01/2016] [Accepted: 11/08/2016] [Indexed: 12/18/2022]
Abstract
Background: There is a lack of study on the relation between undiagnosed diabetes and depression in the general population. Methods: A total of 11,531 adults were examined using a multistage cluster sampling method to select a representative sample of individuals who were at least 35 years old. Subjects were classified into three groups: no diabetes (ND), diagnosed diabetes (DD), and undiagnosed diabetes (UD). The participants were surveyed with the Patient Health Questionnaire-9 (PHQ-9). Results: Of all the 11,531 participants, the prevalence of depression was higher in the DD group than in the other two groups. Multi variable logistic regression analyses show that the DD group had significantly higher odds for depression compared with the ND group (p < 0.01), while the UD group showed no significant differences compared to the ND group. Subgroup analyses show that diagnosed diabetes in subjects with a lower educational level, compared with subjects with an educational level of high school or above, had higher odds for a PHQ-9 score ≥5 (p < 0.01). Conclusion: In this general population, diagnosed but not undiagnosed diabetes was significantly associated with depression. Much higher odds for depression were found among diagnosed diabetic individuals with a lower level of education.
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Affiliation(s)
- Shiwei Liu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China.
| | - Andrew Page
- Centre for Health Research, Western Sydney University, Penrith, NSW 2571, Australia
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