Chinese perspectives on culture and mental health

Mental health help-seeking intentions & coping strategies of Chinese international students in the United States

BACKGROUND

Chinese international students (CIS) in the United States may face unique mental health challenges that are often overlooked in discussions about mainstream college student needs.

OBJECTIVE

This study aims to investigate the predictors of mental health (MH) professional help-seeking intentions among CIS at a large public Midwestern university, as well as the obstacles that hinder their use of professional MH services.

METHODS

The study used quantitative and qualitative approaches to gather data on CIS' help-seeking attitudes. Quantitative analysis focused on the association between specific factors and help-seeking intentions. Qualitative coding of open-ended questions provided additional insights into obstacles and suggestions for improving mental health support.

RESULTS

The study identified several factors influencing the mental health help-seeking intentions of Chinese international students. Two primary negative predictors were a preference for emotional self-control and concerns about the questionable quality of treatment. Conversely, having previous experience with professional mental health services, both in China and the United States, was found to be a positive predictor of help-seeking intentions. Additionally, qualitative analysis of open-ended responses revealed further obstacles to seeking help and provided useful suggestions for enhancing mental health support for Chinese international students in college settings.

CONCLUSIONS

The study identifies key factors that influence CIS' attitudes toward seeking professional mental health services. Understanding these factors can help in developing strategies to better support the mental health of CIS in college settings.

LIMITATIONS

Several limitations must be acknowledged in this study. The cross-sectional design limits the ability to draw causal inferences from the data. Additionally, the sample may not be fully representative of the broader population of Chinese international students, which may affect the generalizability of the findings. Self-reported data may also introduce response biases. Future research should consider longitudinal approaches and a more diverse sample to validate and expand on these findings.

Does culture play a role? A pilot study on Western services for a Chinese-Canadian family with children with Autism spectrum disorder

PURPOSE

Autism spectrum disorder (ASD) affects one in 66 children in Canada, and its symptoms may be particularly challenging for parents from a Chinese background. Further, when working with Chinese families, Western-educated service providers may experience difficulty in applying culturally relevant and family-centered care. This study examined the experiences of one Chinese-Canadian family as they receive intervention services for their two children with ASD.

MATERIALS AND METHODS

This pilot, single-case design, qualitative case study included semi-structured interviews with the parents, grandparents, as well as three service providers' views.

RESULTS

Three major themes emerged from the data in the form of tensions: (1) within the family members; (2) within the therapeutic relationships, and (3) in addressing culture in therapy.

CONCLUSIONS

Results suggested that although the family identified key cultural differences, service providers did not sufficiently address these within the therapeutic relationship, and the need for culturally-relevant and family-centered care was not fulfilled.

The influence of Chinese culture and customs on the beliefs and health-related behaviours of Chinese women with gestational diabetes mellitus: A qualitative study

OBJECTIVE

The study aimed to explore the influence of Chinese culture and customs on the beliefs and health-related behaviours of Chinese women with gestational diabetes mellitus (GDM).

METHODS

This descriptive qualitative study conducted semi-structured interviews with 15 Chinese women between November 2022 and January 2023. The interview data were analysed using thematic analysis.

RESULTS

Three major themes are found: (1) beliefs in health, (2) beliefs in illness and GDM and (3) beliefs in health-related behaviours. They worried about the negative effects of GDM on the infant and family, so they actively sought medical advice to maintain health. However, it is challenging for them to balance adhering to healthcare professionals' advice and avoiding practical difficulties in the impact of the Chinese sociocultural context.

CONCLUSION

This study emphasizes the influence of Chinese culture and customs on the beliefs and health-related behaviours of women with GDM. Healthcare providers should recognize the influence of Chinese culture, customs and beliefs on women with GDM and their families, in order to provide individualized education to help them maintain health-related behaviours.

The Yin–Yang Definition Model of Mental Health: The Mental Health Definition in Chinese Culture

It is a common aim of psychologists to construct a definition model with universal cultural applicability for mental health. These models can be divided into two types in terms of definition: One is the negative mental health definition model based on the absence of mental illness symptoms; the other is the definition model of positive mental health based on subjective feelings, such as happiness and social identity. However, neither of these definitions can properly explain Chinese people’s understanding of mental health or how mental health is dealt with in Chinese culture. This paper proposes a Yin–Yang definition model of mental health based on the theory of personality of Confucianism and Taoism. This model not only properly describes the understanding of mental health in traditional Chinese culture, but also explains East Asian psychotherapy and mental health practices in the context of Chinese culture.

Life Quality in Care Homes: Chinese and Danish Older Adults' Perspectives

The demand for care homes appears to be emerging as a key future trend in response to the burgeoning population of older adults, with the need for care provision increasing accordingly. Life quality, happiness and well-being are important factors associated with the care of older residents. This qualitative study explores how older adults moving into care homes view their life quality, from their own perspectives, in two quite different cultural contexts, Chinese and Danish. Older care residents in Shanghai and Denmark participated in the study by means of semi-structured and in-depth interviews. An interpretive phenomenological analysis approach was used for data analysis. Four interrelated themes were identified: positive transfer; positive environment; positive capability and positive experience. The findings demonstrated that older adults considered their quality of life as the result of a dynamic process. Their pursuit of a harmonious status, centered on "change" as the core value, which encompassed both the simplicities and complexities of life. Both older adult groups cared more about their emotional wellbeing, which focused mainly on positive emotions being stimulated while negative emotions were shunned. In the situations when they were "harmonized" by society systems, there was an important emotional thread which continued throughout their whole life that was strongly associated with life quality which was the relationship with family members - be it in the past, present or future.

The relations between different components of intolerance of uncertainty and symptoms of depression during the COVID-19 pandemic: A network analysis

BACKGROUND

The relations between depression and intolerance of uncertainty (IU) have been extensively investigated during the COVID-19 pandemic. However, there is a lack of understanding on how each component of IU may differentially affect depression symptoms and vice versa. The current study used a network approach to reveal the component-to-symptom interplay between IU and depression and identify intervention targets for depression during the COVID-19 pandemic.

METHODS

A total of 624 college students participated in the current study. An IU-Depression network was estimated using items from the 12-item Intolerance of Uncertainty Scale and the Patient Health Questionnaire-9. We examined the network structure, node centrality, and node bridge centrality to identify component-to-symptom pathways, central nodes, and bridge nodes within the IU-Depression network.

RESULTS

Several distinct pathways (e.g., "Frustration when facing uncertainty" and "Feelings of worthlessness") emerged between IU and Depression. "Fatigue" and "Frustration when facing uncertainty" were identified as the central nodes in the estimated network. "Frustration when facing uncertainty," "Psychomotor agitation/retardation," and "Depressed or sad mood" were identified as bridging nodes between the IU and Depression communities.

CONCLUSION

By delineating specific pathways between IU and depression and highlighting the influential role of "Frustration when facing uncertainty" in maintaining the IU-Depression co-occurrence, current findings may inform targeted prevention and interventions for depression during the COVID-19 pandemic.

Prevalence of Child Maltreatment during the COVID-19 Pandemic: A Cross-sectional Survey of Rural Hubei, China

The impact of lockdown measures in Wuhan, China during the coronavirus disease 2019 pandemic on child maltreatment remains unknown. The present study attempted to estimate the prevalence of child maltreatment during this period, to identify risk factors, and the influence of child maltreatment. A representative sample of 1,062 school-aged children in rural Hubei province was surveyed. Results indicated that the prevalence of family violence, physical violence, emotional abuse and neglect during the lockdown period were 13.9, 13.7, 20.2 and 7.3 percent, respectively, and that of lifetime prevalence were 17.0, 13.9, 14.6 and 6.9 percent, respectively. And most victims did not seek official help. Boys were more likely to experience physical violence. Children from separated/divorced families tended to report more emotional abuse. Those having family members with a history of drug abuse and mental illness were more likely to experience neglect during the lockdown period. All types of child maltreatment were positively associated with self-harm behaviours. These findings highlight the importance of identifying at-risk children immediately and implementing timely intervention programmes to prevent self-harm behaviours for social workers and health professionals.

Mental Health Literacy from the Perspective of Multi-Field Experts in the Context of Chinese Culture

The study aimed to explore the opinions of multi-field Chinese experts on mental health literacy and further build a comprehensive picture of mental health literacy based on these opinions. Semi-structured interviews were conducted with ten Chinese experts from the fields of psychiatry, clinical psychology, mental health education, and social work. A mixed deductive-inductive thematic analysis was used in the analysis of the qualitative data. The experts noted that mental health literacy applies both to persons with mental illness and the people who help them. The comprehensive view of mental health literacy that emerged from the interviews included knowledge about mental illness, an attitude of acceptance, respectful behavior, and recognition of the importance of getting help. Characteristically, Chinese components of mental health literacy included living in harmony with others and achieving balance in all aspects of life. To the best of our knowledge, this is the first qualitative study of experts’ views of the concept of mental health literacy in the context of Chinese culture. The experts’ responses to the interviews generated a comprehensive view of mental health literacy, including several elements that may be especially salient in Chinese culture. The results have implications for researchers and clinicians.

The Role of Intergenerational Relations in the Association between Life Stressors and Depressive Symptoms

This study investigates the association between intergenerational relations and depressive symptoms of older adults in Taiwan. Using data from two waves of the Surveys of Health and Living Status of the Elderly in Taiwan, a population-based sample of adults aged 60 and older, the links between intergenerational relations between parents and their adult children, life stressors (major life events and daily hassles), and depressive symptoms are examined. The authors find that higher reports of exposure to stressors—both daily hassles and major life events—are associated with higher levels of psychological distress. Intergenerational ties with children appear to have only a modest effect on levels of depressive symptoms that depends on both the kind of stressor and the aspect of the parent-child relationship

The Effect of Nursing Interventions Utilizing Music Therapy or Sensory Information on Chinese Patients’ Anxiety Prior to Cardiac Catheterization: A Pilot Study

Background: Unrelieved anxiety can produce an increase in sympathetic nervous system activity leading to an increase in cardiac workload. Nursing interventions using music therapy or sensory information among patients with coronary artery disease has resulted in anxiety reduction, though results in Chinese subjects has not previously been published. Aims: To determine the effects of using nursing interventions of music therapy or sensory information, on reducing anxiety and uncertainty, and improving negative mood among Chinese subjects immediately prior to cardiac catheterization. Methods: An experimental three-group repeated measures design for this pilot study was used. Forty-five hospitalized adults (15/group) undergoing cardiac catheterization were randomly assigned to either (1) a music therapy intervention, (2) a sensory information intervention or (3) treatment as usual (control). Anxiety, uncertainty and mood state were measured using self-reported questionnaires and physiological measures were made at baseline, post-intervention to determine their effect and post-cardiac catheterization to determine whether these interventions had any long-lasting effect. Results: The control group was found to be significantly older ( P=0.001) than the two experimental groups. Older age was associated with lower anxiety scores ( r=−0.31, P=0.04 at baseline; r=−0.30, P=0.04 post-intervention; r=−0.22, P=0.15 post-cardiac catheterization). After controlling for age, the use of music therapy or sensory information did not significantly reduce anxiety, improve mood state, reduce uncertainty, decrease heart or respiratory rate among subjects undergoing cardiac catheterization. Conclusion: The non-significant result may have been affected by the small sample, and the social and cultural expectations regarding the public display of emotions among Chinese populations.

Narratives About Mental Illnesses in China: The Voices of Generation Y

This study explores the cultured understanding of mental health and mental illnesses among members of Generation Y in China through a narrative approach. Five prominent narratives are identified through the analysis of stories about mental illnesses collected through semistructured interviews with college students. These five narratives feature the tragic genius, the psychotic criminal, the fragile victim, the antisocial recluse, and the homosexual. These narratives are gendered, in that women are the primary protagonists in the narrative about the fragile victim, while men are featured prominently in the narratives about the tragic genius, the psychotic criminal, and the antisocial recluse. Our study demonstrates that these narratives are based on, and will further reinforce, highly cultural-specific stereotypes and biases about mental illnesses in China. Theoretical and practical implications of this study are discussed.

Experience of cognitively intact residents cohabitating with residents with dementia in long-term care facilities

A qualitative research approach was used to explore the life experience of cognitively intact (CI) residents cohabitating with residents with dementia in mixed placement facilities. Purposive sampling was used to recruit 21 CI residents from 6 long-term care facilities in southern Taiwan. Using a semi-structured interview guide, data were analyzed by content analysis. Two themes emerged: emotional diversity and coping. Emotional diversity described the wide range of responses, both positive and negative, expressed by the participants. Coping referred to the CI residents' ability to adapt to behaviors exhibited by the residents with dementia and the environment. Results of this study provide nurses and other health care providers with an understanding of the life experience of CI residents who live among residents with dementia. An understanding can lead to improved quality of life and positive social interactions among CI residents and those with dementia.

Impact of Taiwanese culture on beliefs about expressing anxiety and engaging in physical activity: a discursive analysis of the literature

AIMS AND OBJECTIVES

This paper analysed the scholarly discourse about the influence of Taiwanese culture on beliefs about expressing anxiety and engaging in physical activity from literature review.

BACKGROUND

The well-being of individuals with mental illness is promoted by the World Health Organization. Reducing barriers to treatment and care in community health-service systems requires cultural understanding. However, little is known about the influence of Taiwanese culture on physical activity programmes for people with anxiety disorders in Taiwan.

DESIGN

A discursive analysis of the literature.

METHOD

Literature was used to examine the impact of Taiwanese culture on beliefs about anxiety and physical activity from historical, economic, social, political and geographical perspectives.

RESULTS

Taiwanese cultural beliefs about anxiety and physical activity can be summarised into six themes. Beliefs about anxiety are reflected in three themes: anxiety and shame, beliefs against direct communication and beliefs about anxiety and external forces. Beliefs about engaging in physical activity are reflected in three themes: beliefs about human action, the relationship between health and physical activity and priority of academic achievement.

CONCLUSION

This paper exposes the hidden power of culture to influence Taiwanese beliefs about anxiety and physical activity. Three negative beliefs about anxiety influence the expression of anxiety symptoms and help-seeking behaviours. Two positive and one negative belief about physical activity significantly affect choice of activity type and level of participation in physical activity. Anxiety and physical activity have a dynamic relationship and both are deeply influenced by Taiwanese culture.

RELEVANCE TO CLINICAL PRACTICE

An awareness of cultural influences on beliefs about anxiety and physical activity is important when encouraging Taiwanese people with anxiety disorders to engage in physical activity. This awareness may help nurses understand better how their patients perceive anxiety and physical activity, leading to more appropriate physical activity programmes to improve both physical and psychological well-being.

The experiences of carers in Taiwanese culture who have long-term schizophrenia in their families: a phenomenological study

Schizophrenia is a severe illness with little hope of recovery and requires long-term care. The purpose of this study was to explore the experiences of carers who live with someone with long-term schizophrenia, within the cultural context of Taiwan. The study was conducted in a community setting in central Taiwan. A qualitative phenomenological approach was used to explore the experiences of carers. Purposive sampling was used by selecting the carers who were close relatives of the clients, had lived with the clients for at least 1 year and bore most of the responsibilities. Semi-structured face-to-face interviews were conducted to collect the data and narratives were analysed using Colaizzi's (1978) seven-step method. Data saturation was achieved after interviewing 10 carers. Three themes and eight sub-themes were identified: burdens of caring (helping clients' illness, lack of professional support and family conflicts), emotional burdens (sadness, worry and fear) and strategies of coping (cognitive and religious coping strategies). Our study supported the importance for nurses to understand the cultural aspects of mental illness, particularly the widespread cultural beliefs and patterns of help seeking behaviours, in order to provide culturally sensitive health care.

The coping experiences of carers who live with someone who has schizophrenia

AIMS AND OBJECTIVES

The purpose of this study was to understand the coping experiences of carers living with a schizophrenic family member. Our research may be a valuable reference for mental health professionals seeking to improve the quality of care for people with schizophrenia and their carers.

DESIGN

We employed a qualitative descriptive phenomenological research methodology to understand the coping experiences of carers living with a schizophrenic family member.

METHODS

Purposive sampling and in-depth, face-to-face interviews were used to collect data. When data saturation was reached, the sample size comprised 10 carers (five men and five women). The interview focused on the carer's coping experience. During the process of data collection and data analyis we established epoches (bracketing) and returned to the reality of the carers' experience to keep the data objective. Narratives were analysed according to Colaizzi's seven steps method.

RESULTS

The two most commonly used coping mechanisms that emerged from this study were psychological coping strategies (cognitive, behavioural and emotional) and social coping strategies (religious, social and professional support). Furthermore, three factors were found in the study, including low social status, traditional help-seeking behaviours and feelings of shame.

CONCLUSION

Findings from this study demonstrate the importance of understanding the coping experiences of carers who have a family member with schizophrenia. Further research is needed to identify more important detailed factors that affect the coping strategies of carers. Relevance to clinical practice. Community mental health care professionals need to improve the quality of care for helping carers living with a family member who has schizophrenia. It is important to develop effective coping intervention strategies that help carers cope with the stress and strain of caring for a family member with schizophrenia.

Perceptions of depression among elderly Thai immigrants

Because little is known about elderly Thai immigrants' conceptualization of depression, a qualitative descriptive research study was conducted to explore their perception of depression. Semi-structured individual face-to-face interviews were performed with a purposeful sampling of ten men and ten women aged 60 years and older at participants' homes or Thai Buddhist temples. The results revealed that depression was defined as feeling disappointment and pressure in the mind and included symptoms of isolation, heart pounding, and dissatisfaction. Coping strategies comprised practicing Buddhism and acceptance. Gender differences existed and reflected cultural expectations for men and women. These findings provide a foundation for developing culturally sensitive health care.

Being reborn: the recovery process of postpartum depression in Taiwanese women

AIM

This paper reports a qualitative study describing the process of recovery from postpartum depression in Taiwanese women.

METHODS

We carried out a study using grounded theory with a purposive sample of 23 postnatally depressed women in 2001-2002. The Beck Depression Inventory was used to screen for severe depression. Women with scores higher than 16 at 6 weeks after childbirth were categorized as having postpartum depression. Only two out of the 23 mothers were being treated for depression at the time. The data were analysed by constant comparative method.

FINDINGS

'Being reborn' was the core concept that emerged from the data on the mothers' experience of going through postnatal depression, which was a process of descent into near-death insanity and eventual rebirth. Such postnatally depressed mothers often underwent four stages of coping with the loss of self or loss of former identity and attachment to their new lives as mothers. The four stages were: (1) shattered role identity, (2) feeling trapped and breaking down, (3) struggling for self-integrity and (4) regaining vitality.

CONCLUSION

The experience of postpartum depression should be examined within the social and cultural contexts in which it occurs. These Taiwanese data can be used to develop culturally-sensitive health care. The nursing role is primarily that of reflective listening to help the women adjust to the process of being reborn--an internal process of painful growth represented by motherhood and striving to protect the real self in order to maintain emotional health while negotiating a developmental transition. Preventive interventions might include providing guidance for parenting, counselling of individual mothers, and facilitating the development of support groups.

Dimensions of quality in long-term care facilities in Taiwan

AIM

This article presents the results of a qualitative study designed to explore the perceptions of Taiwanese elders about the quality of their care while in residence at a long-term care facility.

BACKGROUND

As the population of elders in Taiwan is increasing rapidly, quality long-term care has become both a necessity and social responsibility. Research related to quality of care has focused on structure, process and outcomes as well as perceptions of quality of care and life satisfaction. Few authors have considered residents' perspectives within a cultural context.

METHOD

A convenience sample of 22 residents, aged between 61 and 86 years and living in four Taiwanese care facilities, participated in semi-structured interviews. The data were generated during 2001/2002 and were analysed using content analysis.

RESULTS

Six key dimensions of quality care were elicited. The dimensions were: a caring attitude, respect for individual differences, emotional support, social interaction, a supportive environment, and accessible care. These dimensions are discussed within a cultural context supportive of family connectedness and filial piety, values underpinning care expectations of elders.

CONCLUSIONS

The findings provide a foundation for increased understanding of the perceived gaps between residents' aspirations about quality care and priorities identified in other studies. Additional studies based on these data are planned in order to generate a culturally relevant, psychometrically sound resident assessment tool to evaluate the quality of care from a resident perspective in long-term care facilities in Taiwan.

The phenomenon of somatization among community Chinese Americans

OBJECTIVE

The phenomenon of somatization was explored in relation to the experiences of acculturation, stress, support, and distress.

METHODS

A representative community sample of 1,747 Chinese Americans (aged 18-65 years), selected by a multi-stage household sampling design, in the Los Angeles County was interviewed to tap their psychiatric diagnoses, symptomatology, level of acculturation, stress, and support.

RESULTS

Across all indices, Chinese Americans' level of somatic symptoms, impairment related to somatization, and percentage of meeting the Somatic Symptom Index 5/5 (SSI 5/5) criterion were comparable to those found in other populations. Length of residence in the U. S. and acculturation were not related to somatization. Regression analyses showed that anxiety, depression, gender, age, education, stressors, and support were significantly related to somatization, ps < 0.05. Somatizers tended to perceive themselves with poor health and utilized both Western and indigenous Chinese medicine.

CONCLUSION

The importance of demographics, psychological distress, and stress was emphasized in the explanation of somatization tendencies among immigrant Chinese Americans. Somatization might be a stress response with regard to increased distress severity and psychosocial stressors rather than a cultural response to express psychological problems in somatic terms.

When Asian immigrant women speak: from mental health to strategies of being

Immigrant women from 5 ethnic-cultural communities (Korean, Hong Kong Chinese, Mainland Chinese, Taiwanese, and Vietnamese) in Toronto, Ontario, Canada participated in a focus group study (13 focus groups of 102 participants) of Asian immigrant women's conceptions of mental health. Their responses challenge the predominant conceptualizations of mental health in North America, the popular characterization of Asian culture as collectivistic, and the stereotypic image of Asian women as defining themselves in family relations. In trying to live a life they desire and to quest for a better state of well-being, these women have asserted their agency to articulate multiple strategies of being.

Postpartum depression and related psychosocial variables in Hong Kong Chinese women: Findings from a prospective study

Research on predictors of postpartum depression (PPD) in Hong Kong (HK) Chinese women is scant. A prospective study with 385 HK Chinese postpartum women was conducted to identify correlations between PPD and demographic variables, and antenatal depression and psychosocial variables, and to determine which of these variables were predictors of PPD. Using the Edinburgh Postnatal Depression Scale (EPDS), we classified 19.8% of participants as postnatally depressed. Fifty-six percent of the variance in PPD was explained by social support and stress factors. However, social support factors accounted for only a small percentage of that variance. The major predictors were antenatal depression, postnatal perceived stress, and childcare stress. HK women may benefit from a culturally appropriate intervention focused on reducing stress in the postpartum period.

The cultural context of adjusting to nursing home life: Chinese elders' perspectives

PURPOSE

Although there is a body of knowledge relating to the different challenges residents encounter after nursing home placement, less is known about the actual process of how they handle these challenges and adjust after such placement. This study described the process whereby Hong Kong Chinese residents adjust following nursing home placement.

DESIGN AND METHODS

The grounded theory methodology was employed. Data were collected from 98 interviews with 18 residents newly admitted to a nursing home in Hong Kong one week after admission and then monthly until no new information about their adjustment experiences could be discovered. Data were analyzed using constant comparative analysis.

RESULTS

Newly admitted elders adjusted through the four stages of orienting, normalizing, rationalizing, and stabilizing as they struggled to regain normality with a life that was as close to that lived before admission as possible. A number of experiences suggested in the literature as barriers to adjustment, such as living with rules and regulations, and the communal nature of nursing home life were not regarded as important by Chinese elders. However, establishing relations with other residents was a particular challenge for them.

IMPLICATIONS

Interventions to promote adjustment should aim to assist with the process of regaining normality with the different aspects of nursing home living, taking into consideration residents' life experience and sociocultural values.

A qualitative study of the experiences of a group of Hong Kong Chinese women diagnosed with postnatal depression

AIM OF THE STUDY

To examine the lived experiences of a group of Hong Kong Chinese women diagnosed with postnatal depression.

BACKGROUND

Postnatal depression affects approximately 1 in 10 childbearing women in Hong Kong. However, most studies of postnatal depression have been carried out in Western societies and no qualitative research was found describing the experience of Hong Kong Chinese mothers with postnatal depression.

DESIGN

A phenomenological study was conducted. Data were collected by semi-structured interviews. A purposive sample of 35 women diagnosed with postnatal depression was interviewed. Interview data were analysed following Colaizzi's phenomenological methodology.

RESULTS

Themes that emerged describing participants' experiences included trapped in the situation, ambivalent towards the baby, uncaring husband, and controlling and powerful in-laws. Women felt hopelessness, helplessness and loss of control. They were trapped in a situation that had no way of escape except by violent means, such as homicide or suicide. Feelings towards the baby were ambivalent, both hate and love. Several women had injured, or had thought of injuring or killing, their babies and/or themselves. Women's unhappiness was attributed to a noncaring husband, and controlling and powerful in-laws. Generally, women did not seek help until their depression was diagnosed by screening tests.

CONCLUSION

This study has revealed insights into how women experienced postnatal depression in Hong Kong, and what they perceived as contributing to their depression. These insights may be used to guide interventions for women and their families to raise awareness regarding the support childbearing women need.

Cognitive behavioural therapy for clients with schizophrenia: implications for mental health nursing practice

1. This paper discusses the application of cognitive behavioural therapy (CBT) in the treatment of clients with schizophrenia and the implications for mental health nursing practice. 2. The literature shows that CBT has positive effects for clients in improving mental state and reducing relapse rate. 3. Because of their direct client contact, mental health nurses are in the best position to assess, address and manage clients' psychotic symptoms and problems. 4. A nursing care plan is used to illustrate how the principles of CBT could be incorporated into nursing care. 5. Education and training are important to equip nurses with the necessary knowledge and skills to implement the therapy. 6. Nurses have to take into account cultural issues related to the use of CBT. 7. Culturally sensitive research needs to be conducted to assess the outcome of the therapy.

Psychosocial consequences of falling: the perspective of older Hong Kong Chinese who had experienced recent falls

AIM OF THE STUDY

The study's aim was to explore the psychosocial consequences of falling with a group of older Chinese who had recently fallen.

BACKGROUND

Older people fall more frequently. Thus, the consequences of these falls and their influence on health outcomes need to be determined. One important outcome, namely the psychosocial consequence of falling, has not been extensively studied. As a result, this study explored the psychosocial consequences of falling with a group of older Chinese who had recently experienced a fall.

RESEARCH APPROACH

An explorative qualitative approach with semi-structured interviews was used in this study.

SAMPLE

Twenty informants, with recent fall experiences either in the community or hospital setting, were interviewed in two elder care wards in an acute care hospital.

FINDINGS

Three major categories of psychosocial consequences of falling emerged from the interview data: powerlessness, fear and seeking care. Powerlessness was also exemplified in three subcategories: lack of control, self-comforting and lack of emotion. Informants perceived falls as unpredictable and not preventable, expressing fears that falling could result in dependence on others and becoming a care burden. The interview data also showed that there is a need by older Chinese to seek care and advice from relatives and health care professionals.

CONCLUSIONS

Findings from this study have provided insights into the psychosocial consequences of falling for older Chinese. These insights suggest nursing interventions should promote a sense of mastery in prevention of falls, facilitate supportive social interactions with relatives and give empathetic responses to those who have fallen.

Perceptions of Hong Kong Chinese elders on adjustment to residential care

While there is an increasing number of elders moving into residential care homes in Hong Kong, very little is known about how they adjust to the changes associated with living in such homes. A grounded theory study was therefore conducted to explore the processes through which Chinese elders adjust following a move to residential care. Audiotaped in-depth interviews were conducted with 18 elders one week after residential home admission and then every month until no new information about their adjustment experiences could be discovered. Constant comparative analysis of data revealed that newly admitted elders adjust through the four stages of orienting, normalizing, rationalizing and stabilizing as they struggle to regain normality in a life that is as close to that lived before admission as possible. The purpose of this paper is to report on Chinese elders' normalizing experiences in the second stage of adjustment. It found that a number of experiences suggested in the literature, as barriers to residential living, such as living with rules and regulations, lack of privacy and autonomy, are not regarded as important by Chinese elders. However, establishing relations with other residents and staff appears to be a particular challenge. It concludes that the life experience and socio-cultural values of Chinese elders have to be addressed when trying to effectively help Chinese elders adjust to life in residential care. The findings also highlight the need for better collaboration between nursing and social work staff in their efforts to promote elders' adjustment.

Transition to residential care: experiences of elderly Chinese people in Hong Kong

A qualitative study was designed to explore the experiences of transition into residential care among elderly Chinese people in Hong Kong. With the elderly people's consent, in-depth interviews were conducted with 10 residents 1 week after their admission into a residential care home. The purpose of the interviews was to explore what the transition experience was like for the Chinese elders and how they settled into residential life. Content analysis of the interview data revealed the significance of cultural influences in the transition experiences. A number of issues suggested in the literature as barriers to adjustment to residential care, such as living with rules and regulations, lack of privacy and autonomy were not regarded as important by the Chinese elders. The Chinese values of balance, harmony and collectivism have made it easier for them to remain open and accept the communal way of living. Yet, these same values have restricted the elders in developing new relationships with staff and other residents. This appears to be the particular challenge facing Chinese elderly residents. Implications for professionals working with elderly residents are discussed in the light of these findings.

Mental health nursing and cultural diversity

The focus of this article is on ethnic cultural difference. The establishment of a bi-cultural model of health care delivery has been a recent priority in New Zealand. Bi-culturalism has become an important concept for Maori and Pakeha (Europeans), working in partnership in the planning and implementation of mental health services in New Zealand. Adoption of the principles of respect and recognition of the uniqueness of different cultural identities, by nurses, has meant that clients who use mental health services in New Zealand are beginning to benefit from nursing care that is culturally competent.

Mental disorders and syndromes found among Asians residing in the United States

The Asian population in the United States is the fastest growing minority; consequently it behooves psychiatric nurses and other mental health professionals to be aware of symptom presentation of emotional problems that may differ from those of other population groups. Specific syndromes, psychiatric disorders, and symptoms that commonly present as physical disorders are discussed. Recommended adaptations of psychiatric interventions, including medications and other therapies, are offered to enable mental health professionals to provide culturally sensitive care. Mental health care that is culturally competent may improve access to care for Asians residing in the United States.