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Rudenstrand H, Bäärnhielm S. A qualitative study about explanatory models of alcohol use disorder among patients and relatives in a Ugandan mental hospital. BMC Psychiatry 2024; 24:222. [PMID: 38515058 PMCID: PMC10958892 DOI: 10.1186/s12888-024-05677-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 03/12/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Alcohol use disorder (AUD) is a major clinical problem in Uganda. Explanatory models (EMs) of illness are important as they have consequences for treatment. Clinicians´ knowledge about patients´ EMs can improve understanding of the latter´s perspectives and adapting treatments. There is a lack of African studies about EMs of AUD. The aim of this study was to explore EMs for AUD among hospitalized patients and their relatives at the alcohol and drug unit (ADU) at Butabika hospital in Uganda. METHODS An adapted version of the Explanatory Model Interview Catalogue (EMIC) was used for interviews with ten patients and five relatives to investigate how both hospitalized patients with AUD and their relatives understand the disease. Data were analysed for themes with a qualitative content analysis and support of the software program, OpenCode 4.03. RESULTS Five major themes were identified from the patient interviews: "Context promotes AUD"; "Alcohol is part of culture"; "Spiritual causes of AUD in the community"; "Help through Western medicine and religious sources is preferred" and "Social problems and stigmatization". Six major themes identified from the interviews with relatives were: "Numerous causes of drinking alcohol"; "Devastating consequences of drinking alcohol"; "Exploiting persons with AUD"; "Others' suffering"; "Relatives struggling for help" and "Suggested solutions". CONCLUSIONS Patients' EMs of AUD included social and spiritual explanations. Alcohol is seen as an important part of the Ugandan culture among both patients and their relatives. The results indicate it is important in clinical contexts to investigate the EMs of the patients and relatives to individually tailor treatment interventions.
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Affiliation(s)
| | - Sofie Bäärnhielm
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Transcultural Centre, Region Stockholm, Stockholm, Sweden.
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Ahuvia IL, Sotomayor I, Kwong K, Lam FW, Mirza A, Schleider JL. Causal beliefs about mental illness: A scoping review. Soc Sci Med 2024; 345:116670. [PMID: 38402842 DOI: 10.1016/j.socscimed.2024.116670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/02/2023] [Accepted: 02/07/2024] [Indexed: 02/27/2024]
Abstract
Research on causal beliefs about mental illness-the beliefs people hold about what causes a particular mental illness, or mental illnesses in general-is split across a number of theories and disciplines. Although research on this subject has provided a number of insights and practical applications, the diversity of theories, terminology, and keywords makes it challenging for a new reader to gain a comprehensive understanding. We sought to address this by conducting a systematic scoping review of research on causal beliefs. This review included English-language articles from any year that mentioned causal beliefs for mental illness in their title or abstract. We identified articles in two stages. In the first stage, we used a narrow set of search terms referring specifically to causal beliefs (1227 records identified, 417 included). In the second stage, we used a comprehensive set of terms relevant to research on causal beliefs (10,418 records identified, 3838 included). We analyzed articles qualitatively, organizing them into one of five theories or categories: the common-sense model of self-regulation, explanatory models, mental health literacy, biogenetic causal beliefs, and other research on causal beliefs. We provide a comprehensive summary of these literatures in terms of their history, typical research questions and study design, findings, and practical applications. These theories differ in their theoretical orientation towards causal beliefs, research methods, findings, and applications. However, they broadly share a view of causal beliefs as multifaceted, culturally determined, and relevant for additional psychosocial variables such as mental illness stigma and help-seeking. We conclude by making recommendations for researchers, clinicians, public health messaging, and for individuals with mental illness.
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Affiliation(s)
- Isaac L Ahuvia
- Stony Brook University, Department of Psychology Stony Brook University, Stony Brook, NY, 11794-2500, USA.
| | - Ian Sotomayor
- Stony Brook University, Department of Psychology Stony Brook University, Stony Brook, NY, 11794-2500, USA
| | - Kelly Kwong
- Stony Brook University, Department of Psychology Stony Brook University, Stony Brook, NY, 11794-2500, USA
| | - Fiona W Lam
- Stony Brook University, Department of Psychology Stony Brook University, Stony Brook, NY, 11794-2500, USA
| | - Aqsa Mirza
- New York University Steinhardt School of Culture, Education, and Human Development 246 Greene St. New York, NY 10003, USA
| | - Jessica L Schleider
- Northwestern University Feinberg School of Medicine Department of Medical Social Sciences, 625 N. Michigan Ave., 21st Floor, Chicago, IL, 60611, USA
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Negussie H, Getachew M, Deneke A, Tadesse A, Abdella A, Prince M, Leather A, Hanlon C, Willott C, Mayston R. "Problems you can live with" versus emergencies: how community members in rural Ethiopia contend with conditions requiring surgery. BMC Health Serv Res 2024; 24:214. [PMID: 38365723 PMCID: PMC10874059 DOI: 10.1186/s12913-024-10620-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/18/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND 98% of people with surgical conditions living in low- and middle-income countries (LMICs) do not receive safe, timely and affordable surgical and anesthesia care. Research exploring barriers to receiving care has tended to be narrow in focus, often facility-based and ignoring the community beliefs, experiences and behaviours that will be an essential component of closing the gap in surgical care. Using qualitative methods, we captured diverse community perspectives in rural Ethiopia: exploring beliefs, perceptions, knowledge and experiences related to surgical conditions, with the overall aim of (re)constructing explanatory models. METHODS Our study was nested within a community-based survey of surgical conditions conducted in the Butajira Health and Demographic Surveillance Site, southern Ethiopia, and a follow-up study of people accessing surgical care in two local hospitals. We carried out 24 semi-structured interviews. Participants were community members who needed but did/did not access surgical care, community-based healthcare workers and traditional bone-setters. Interviews were conducted in Amharic, audio-recorded, transcribed, and translated into English. We initially carried out thematic analysis and we recognized that emerging themes were aligned with Kleinman's explanatory models framework and decided to use this to guide the final stages of analysis. RESULTS We found that community members primarily understood surgical conditions according to severity. We identified two categories: conditions you could live with and those which required urgent care, with the latter indicating a clear and direct path to surgical care whilst the former was associated with a longer, more complex and experimental pattern of help-seeking. Fear of surgery and poverty disrupted help-seeking, whilst community narratives based on individual experiences fed into the body of knowledge people used to inform decisions about care. CONCLUSIONS We found explanatory models to be flexible, responsive to new evidence about what might work best in the context of limited community resources. Our findings have important implications for future research and policy, suggesting that community-level barriers have the potential to be responsive to carefully designed interventions which take account of local knowledge and beliefs.
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Affiliation(s)
- Hanna Negussie
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT- Africa), College of Health Sciences, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia.
| | - Medhanit Getachew
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT- Africa), College of Health Sciences, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia
| | - Andualem Deneke
- Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Amezene Tadesse
- Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ahmed Abdella
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Martin Prince
- King's Global Health Institute, King's College London, London, UK
| | - Andrew Leather
- King's Centre for Global Health and Health Partnerships, School of Life Course and Population Sciences, King's College London, London, UK
| | - Charlotte Hanlon
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT- Africa), College of Health Sciences, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Chris Willott
- King's Centre for Global Health and Health Partnerships, School of Life Course and Population Sciences, King's College London, London, UK
| | - Rosie Mayston
- Global Health & Social Medicine, King's College London, London, UK
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Apers H, Nöstlinger C, Van Praag L. Explanatory Models of (Mental) Health Among Sub-Saharan African Migrants in Belgium: A Qualitative Study of Healthcare Professionals' Perceptions and Practices. Cult Med Psychiatry 2023; 47:878-897. [PMID: 36939966 PMCID: PMC10026223 DOI: 10.1007/s11013-023-09816-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 03/21/2023]
Abstract
Culturally differing approaches to the distinction between physical and mental health contribute to cultural differences in explanatory models of what we call "mental" health in a Western context. For this reason, we use "(mental) health" in this study when referring to these models or differences in understanding. This interpretative, interview-based qualitative study focuses on Belgian mental health professionals' perceptions of the (mental) health explanatory models held by their patients of sub-Saharan African (SSA) descent. The study goals were threefold: first, to assess professionals' perceptions of the explanatory models of their patients of SSA descent; second, to examine how these perceptions influence treatment practices; and third, to investigate the role of the professionals' cultural backgrounds, comparing the results between professionals with and without an SSA background. Twenty-two in-depth interviews with mental health professionals were thematically analyzed, with ten of the participants of SSA descent. Results show that all professionals perceived differences between Western and SSA explanatory models of (mental) health. Causal beliefs were mentioned as the most important difference, including their influence on coping strategies and health-seeking behavior among patients of SSA descent. Professionals' perceptions and familiarity with SSA explanatory models of (mental) health affected their treatment practices. Language and conceptual interpretation difficulties were encountered less frequently by professionals of SSA descent. Those with a Western background applied "culturally sensitive" practices, while professionals of SSA descent implemented an integrated approach. These results contribute to ongoing discussions about what is considered "cultural competency."
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Affiliation(s)
- Hanne Apers
- Centre for Migration and Intercultural Studies/Centre for Population, Family and Health, University of Antwerp, Kipdorp 61, 2000 Antwerp, Belgium
| | - Christiana Nöstlinger
- Department of Public Health, Institute for Tropical Medicine Antwerp, Nationalestraat 155, 2000 Antwerp, Belgium
| | - Lore Van Praag
- Erasmus School of Social and Behavioral Sciences, Erasmus University Rotterdam, Mandeville Building, Burgemeester Oudlaan 50, 3062 PA Rotterdam, The Netherlands
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Saunders C, Treufeldt H, Rask MT, Pedersen HF, Rask C, Burton C, Frostholm L. Explanations for functional somatic symptoms across European treatment settings: A mixed methods study. J Psychosom Res 2023; 166:111155. [PMID: 36680846 DOI: 10.1016/j.jpsychores.2023.111155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/06/2023] [Accepted: 01/07/2023] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Engaging patients in treatment for functional somatic symptoms (FSS) relies on a shared understanding of the mechanisms underlying the complaints. Despite this, little is known about the explanatory models used in daily clinical practice. We aim to examine the approaches healthcare professionals use to explain FSS across European healthcare settings. METHODS This is an exploratory mixed methods study, combining sequential qualitative and quantitative analyses. 3 types of data were collected: a survey of Health-Care Professionals (HCPs) with special interest in FSS from 16 European countries (n = 186), Patient Education Material collected systematically from survey respondents (n = 72) and semi-structured Interviews with HCPs (n = 14). Survey results are summarized descriptively. Qualitative data was thematically coded following template analysis methods. Findings were integrated through mixed-methods triangulation. RESULTS Five main explanatory models for FSS that are used across treatment settings and diagnostic constructs were represented in the data. The 'Multisystem Stress' Approach explains FSS through physiological stress responses within a bio-psycho-social paradigm. 'Sensitized Alarm' and 'Malfunctioning software' are both approaches derived from the neurosciences. Explanations related to 'Embodied Experience' are often used within integrated psychosomatic therapies. In the person-centred 'Symptoms' approach, HCPs aim for co-constructed, individualized explanations. These approaches, which rely on different models of mind-body-environment are complementary and are used flexibly by skilled HCPs. CONCLUSION Taken together the explanatory models described might form the basis of a curriculum of medical explanation with the potential to equip clinicians to form more collaborative relationships with patients across healthcare.
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Affiliation(s)
- Chloe Saunders
- Faculty of Health, Aarhus University Hospital, Denmark; Department for Functional Disorders and Psychosomatic Medicine, Aarhus University Hospital, Denmark.
| | - Hõbe Treufeldt
- Academic Unit of Primary Care, University of Sheffield, UK
| | - Mette Trøllund Rask
- Faculty of Health, Aarhus University Hospital, Denmark; Department for Functional Disorders and Psychosomatic Medicine, Aarhus University Hospital, Denmark
| | - Heidi Frølund Pedersen
- Faculty of Health, Aarhus University Hospital, Denmark; Department for Functional Disorders and Psychosomatic Medicine, Aarhus University Hospital, Denmark
| | - Charlotte Rask
- Faculty of Health, Aarhus University Hospital, Denmark; Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Denmark
| | - Chris Burton
- Academic Unit of Primary Care, University of Sheffield, UK
| | - Lisbeth Frostholm
- Faculty of Health, Aarhus University Hospital, Denmark; Department for Functional Disorders and Psychosomatic Medicine, Aarhus University Hospital, Denmark
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Elliott M. Explanatory models of mental illness among working professionals diagnosed with bipolar or depression in the United States. Int J Soc Psychiatry 2023; 69:476-482. [PMID: 35791623 DOI: 10.1177/00207640221109156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND People diagnosed with mental illness develop a variety of explanatory models of their conditions in the face of uncertainty. Explanatory models matter because they are associated with internalized stigma and illness behaviors such as treatment preferences. AIMS This paper explores how working professionals in the United States draw on biological and/or environmental factors to explain the cause(s) of their diagnoses of bipolar or depression. METHOD Findings are derived from an analysis of transcripts of in-depth interviews with 52 individuals from across the United States who were invited to participate in a study of working professionals diagnosed with mental illness. About 25 self-identified as having bipolar disorder and 27 as having major depression. Transcript data were analyzed following the principles of flexible coding with the goal of establishing a typology of explanatory models of self-identified bipolar versus depression. RESULTS Six types of explanatory models emerged from the analysis. One was exclusively biological, a second was exclusively environmental, and the remaining four combined biological and environmental factors in different ways. Quotations from the interviews are provided to illustrate each type, and comparisons between types are made based on primary diagnosis (bipolar vs. depression), and self-reports of trauma and stressful experiences. CONCLUSION Implications for the future research on explanatory models and how they may impact people who are diagnosed with a mental illness across multiple dimensions of their lives are presented.
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Uscamayta Ayvar M, Sanchez Garrafa R, Escobar JI, Gallo C, Vaisberg A, Poletti G, de Erausquin GA. Non-affective psychosis in traditional Andean culture. Transcult Psychiatry 2022:13634615221099795. [PMID: 35975582 PMCID: PMC10332109 DOI: 10.1177/13634615221099795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report a case of non-affective psychosis with a brief discussion of the phenomenology and its characterization and treatment by traditional Inka healers and eventually by Western-trained psychiatrists. Traditional Inka psychopathology provided empirical support for the transcultural stability of the Kraepelinian dichotomy.
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Affiliation(s)
- Marucela Uscamayta Ayvar
- Glenn Biggs Institute for Alzheimer’s & Neurodegenerative Diseases, UT Health San Antonio, San Antonio, TX, USA
| | - Rodolfo Sanchez Garrafa
- Unidad de Post-Grado, Facultad de Ciencias Sociales, Universidad Mayor de San Marcos, Lima, Peru
| | - Javier I. Escobar
- Rutgers Global Health Institute, Rutgers University School of Medicine, Piscataway, NJ, USA
| | - Carla Gallo
- Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Abraham Vaisberg
- Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Giovanni Poletti
- Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Gabriel A. de Erausquin
- Glenn Biggs Institute for Alzheimer’s & Neurodegenerative Diseases, UT Health San Antonio, San Antonio, TX, USA
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Gureje O, Ojagbemi A. Applicability and future status of schizophrenia as a construct in Africa. Schizophr Res 2022; 242:52-55. [PMID: 35151534 DOI: 10.1016/j.schres.2022.01.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/14/2022] [Accepted: 01/14/2022] [Indexed: 10/19/2022]
Affiliation(s)
- Oye Gureje
- Department of Psychiatry, University of Ibadan, Nigeria; Department of Psychiatry, Stellenbosch University, South Africa.
| | - Akin Ojagbemi
- Department of Psychiatry, University of Ibadan, Nigeria
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Spray J, Hunleth J, Ruiz S, Maki J, Fedele DA, Prabhakaran S, Fechtel H, Shepperd JA, Bowen DJ, Waters EA. How do embodied experiences of asthma influence caregiver conceptual models? Soc Sci Med 2022; 294:114706. [PMID: 35033796 PMCID: PMC10389678 DOI: 10.1016/j.socscimed.2022.114706] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 02/05/2023]
Abstract
RATIONALE Many studies propose that patients', caregivers', and children's asthma management practices may diverge from biomedical recommendations because their understandings of asthma (i.e., conceptual models) are different from biomedical perspectives. However, little research in this area has examined conceptual models of asthma using embodiment theory, which suggests that caregivers' and children's experiences of the physical body shape their perspectives and consequent management strategies. OBJECTIVE We investigated how two embodied processes of symptom perception-detection and interpretation-may influence caregiver or patient conceptions of asthma. METHODS We interviewed 41 caregivers of children with asthma in Gainesville, Florida, and St. Louis, Missouri, and conducted ethnographic visits or virtual interviews with 19 children with asthma aged 6-16. RESULTS Four aspects of asthma's embodied experience shaped conceptual models via processes of detection and interpretation: 1) symptoms are experienced in the context of other bodily processes; 2) acute symptoms and exacerbations are more salient than their absence; 3) the embodied experience of asthma is one of integrated physiological and emotional processes; and 4) caregivers and children acquire embodied practices of perceiving symptoms that produce embodied knowledge. CONCLUSION Participant narratives suggest that embodied experiences of asthma shape caregivers' and children's understandings of asthma in ways that differ from the biomedical model. We argue that a focus on embodied experiences may provide important ground for mutual understanding and communication between providers and caregivers and/or patients.
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Affiliation(s)
- Julie Spray
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, United States
| | - Jean Hunleth
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, United States
| | - Sienna Ruiz
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, United States
| | - Julia Maki
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, United States
| | - David A Fedele
- Department of Clinical & Health Psychology, University of Florida, United States
| | | | - Hannah Fechtel
- Department of Psychology, University of Florida, United States
| | | | - Deborah J Bowen
- School of Public Health, University of Washington, United States
| | - Erika A Waters
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, United States.
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Brea Larios D, Sandal GM, Guribye E, Markova V, Sam DL. Explanatory models of post-traumatic stress disorder (PTSD) and depression among Afghan refugees in Norway. BMC Psychol 2022; 10:5. [PMID: 34983663 PMCID: PMC8728976 DOI: 10.1186/s40359-021-00709-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 12/20/2021] [Indexed: 11/04/2022] Open
Abstract
Background The current situation in Afghanistan makes it likely that we are facing a new wave of Afghan refugees, warranting more knowledge about how to deal with mental health problems among them. This study aims to gain more knowledge on Explanatory Models (EM) of depression and post-traumatic stress disorders (PTSD) among Afghan refugees resettled in Norway.
Methods We conducted six gender-separated, semi-structured focusgroup interviews based on vignettes with Afghan refugees (total N = 27). The vignettes described a fictional character with symptoms of either depression or PTSD symptoms in line with DSM-5 and ICD-10 criteria.
Results The findings showed that EM varied with gender, age, generation, and migration stories. Participants suggested different potential causes, risk factors, and ways of managing symptoms of depression and PTSD depending on the context (e.g., in Norway vs. Afghanistan). In describing the causes of the depression/PTSD in the vignettes, females tended to emphasize domestic problems and gender issues while males focused more on acculturation challenges. The younger males discussed mostly traumatic experiences before and during flight as possible causes. Conclusion The practice of condensing a single set of EMs within a group may not only be analytically challenging in a time-pressed clinical setting but also misleading. Rather, we advocate asking empathic questions and roughly mapping individual refugee patients’ perceptions on causes and treatment as a better starting point for building trusting relationships and inviting patients to share and put into practice their expertise about their own lives. Supplementary Information The online version contains supplementary material available at 10.1186/s40359-021-00709-0.
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Affiliation(s)
- Dixie Brea Larios
- Department of Psychosocial Science, University of Bergen, Christies Gate 12, Postboks 7807, 5015, Bergen, Norway.
| | - Gro Mjeldheim Sandal
- Department of Psychosocial Science, University of Bergen, Christies Gate 12, Postboks 7807, 5015, Bergen, Norway
| | | | - Valeria Markova
- Department of Pulmonology, Haukeland University Hospital, Bergen, Norway
| | - David Lackland Sam
- Department of Psychosocial Science, University of Bergen, Christies Gate 12, Postboks 7807, 5015, Bergen, Norway
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Jacob JA, Aleyamma TK, Kuruvilla A, Gopalakrishnan R. Common mental disorders, quality of life and explanatory models in men undergoing infertility treatment in a tertiary care hospital: A cross-sectional study. J Psychosom Res 2021; 147:110536. [PMID: 34087501 DOI: 10.1016/j.jpsychores.2021.110536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Men with infertility experience significant distress, however research on psychiatric morbidity among this group is limited. Literature on explanatory models of infertility, which influence help seeking behaviour is also scarce. OBJECTIVES The aim of this cross-sectional study was to assess the prevalence and factors associated with psychiatric morbidity among men with infertility, their quality of life, and explanatory models regarding infertility. MATERIALS AND METHODS One hundred and thirty-five consecutive males who attended the reproductive medicine outpatient clinic in a tertiary care hospital were recruited after obtaining informed consent. Psychiatric morbidity, quality of life and explanatory models were assessed using the Clinical Interview Schedule - Revised, Fertility Quality of Life scale and modified Short Explanatory Model Interview respectively. Socio-demographic and clinical details were recorded using a structured proforma. RESULTS Common mental disorder (CMD), observed in one third of the sample, was associated with longer duration of infertility and treatment, family history of psychiatric illness, sexual dysfunction, and past psychiatric illness in spouse. Presence of CMD was associated with lower quality of life scores. Participants held simultaneous and multiple explanatory models for infertility. CONCLUSION Men with infertility experience psychological distress that can further impair their quality of life. They should be offered support and psychosocial interventions as they undergo infertility treatment.
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Affiliation(s)
- Jibi Achamma Jacob
- Department of Psychiatry, Christian Medical College, Vellore, Tamil Nadu 632 002, India
| | - Thaiparambil K Aleyamma
- Department of Reproductive Medicine and Surgery, Christian Medical College, Vellore, Tamil Nadu 632 004, India
| | - Anju Kuruvilla
- Department of Psychiatry, Christian Medical College, Vellore, Tamil Nadu 632 002, India
| | - Rajesh Gopalakrishnan
- Department of Psychiatry, Christian Medical College, Vellore, Tamil Nadu 632 002, India.
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Sarudiansky M, Lanzillotti AI, Oddo S, Kochen S, D'Alessio L, Pablo Korman G. Patients' Explanatory Models about drug-resistant epilepsy in Argentina. A thematic analysis. Seizure 2021; 91:409-16. [PMID: 34303914 DOI: 10.1016/j.seizure.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/02/2021] [Accepted: 07/05/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The aim of this study is to explore explanatory models (EM) about epilepsy in patients with drug-resistant epilepsy (DRE) in Buenos Aires, Argentina. DESIGN A qualitative approach gathered data through semi-structured interviews, oriented to gain an in-depth and contextual understanding of EM about epilepsy of patients with DRE. Data collection and analysis were followed by an inductive and interpretive approach informed by the principles of thematic analysis. RESULTS 75 patients from two public hospitals participated. Emerging codes were grouped into three categories: Biomedical EM, Psychosocial EM, and Traditional EM. Also, factors that trigger or increase the frequency of seizures were reported. CONCLUSIONS Patients' EM regarding epilepsy are complex, as biological, psychological, and supernatural aspects intertwine. EM represent a method of understanding the way people explain, recognize, and act in relation to a medical condition. Since patients' beliefs regarding their illness are related to mental disorders, and quality of life, EM could shed light on the real impact of illness in the life of people, and, in turn, guide those intervention strategies to the patients' subjectivity, in order to improve the treatment compliance, reduce distress, and improve health-related quality of life, among other aspects.
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Sanuade OA, Dodoo FNA, Koram K, de-Graft Aikins A. Explanatory models of stroke in Ghana: perspectives of stroke survivors and their caregivers. Ethn Health 2021; 26:697-719. [PMID: 30922062 DOI: 10.1080/13557858.2018.1557116] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 12/01/2018] [Indexed: 06/09/2023]
Abstract
Objective: This study examines explanatory models (EMs) of stroke and its complications among people living with stroke, and their caregivers, in two urban poor communities in Accra (Ga Mashie) and Korle Bu Teaching Hospital (KBTH), Accra.Methods: Twenty-two stroke survivors and 29 caregivers were recruited from 2 urban poor communities in Accra and KBTH. Qualitative data were obtained using semi-structured interviews that lasted between 45 minutes and 2 hours. The interviews were audiotaped, transcribed and analysed thematically, informed by the concept of EMs of illness.Results: Participants referred to stroke as a sudden event and they expressed different emotional responses after the stroke onset. Stroke survivors and their caregivers attributed stroke with poor lifestyle practices, high blood pressure, unhealthy diet and dietary practices, supernatural causes, stress, family history, other chronic diseases, and delay in treatment of symptoms. While the stroke survivors associated stroke complications with physical disability and stigmatisation, the caregivers associated these with physical disability, behavioural and psychological changes, cognitive disability and death. These associations were mostly influenced by the biomedical model of stroke.Conclusion: The biomedical model of stroke is important for developing interventions that will be accepted by the stroke survivors and the caregivers. Nevertheless, sociocultural explanations of stroke need to be taken into consideration during delivery of medical information to the participants. This study proposes an integrated biopsychosociocultural approach for stroke intervention among the study participants.
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Affiliation(s)
| | | | - Kwadwo Koram
- The Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Ama de-Graft Aikins
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
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Aarethun V, Sandal GM, Guribye E, Markova V, Bye HH. Explanatory models and help-seeking for symptoms of PTSD and depression among Syrian refugees. Soc Sci Med 2021; 277:113889. [PMID: 33838449 DOI: 10.1016/j.socscimed.2021.113889] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/18/2021] [Accepted: 03/27/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study investigates how Syrian refugees explain and prefer to seek help for symptoms of post-traumatic stress disorder (PTSD) and depression. METHODS We conducted five semi-structured focus group interviews based on a vignette-technique with Syrian refugees (n = 21 men, n = 10 women). The vignettes describe a fictional person suffering from symptoms of PTSD or depression in line with DSM-5 and ICD-10 criteria. RESULTS Despite never mentioning PTSD, participants in the PTSD-interviews recognized the symptoms. They perceived them as a common reaction to extreme situations, mainly the war, the flight, and post-migratory stressors. Depression was labeled as either depression or feelings caused by social problems, and the participants were more hesitant to identify with these symptoms. Despite some differences, both the PTSD and depression vignettes were explained in terms of situational explanatory models and externally caused stress. The main finding is how participants described changing stressors resulting from migration and resettlement leading to a difference in how they would seek help in Syria and in Norway. Specifically, we found that preferred help-seeking and coping strategies are contextual. CONCLUSIONS These findings point to the need to consider transformations following forced migration when studying aspects of explanatory models, preferred help-seeking, and coping strategies in refugee groups.
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Affiliation(s)
- V Aarethun
- University of Bergen, Faculty of Psychology, Department of Psychosocial Science, Christies gate 12, 5015, Bergen, Norway.
| | - G M Sandal
- University of Bergen, Faculty of Psychology, Department of Psychosocial Science, Christies gate 12, 5015, Bergen, Norway.
| | - E Guribye
- NORCE Research, Universitetsveien 19, 4630, Kristiansand, Norway.
| | - V Markova
- University of Bergen, Faculty of Psychology, Department of Psychosocial Science, Christies gate 12, 5015, Bergen, Norway; SEMI, Center for Migration Health, Bergen Municipality, Norway.
| | - H H Bye
- University of Bergen, Faculty of Psychology, Department of Psychosocial Science, Christies gate 12, 5015, Bergen, Norway.
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Bith-Melander P, Ratliff J, Poisson C, Jindal C, Ming Choi Y, Efird JT. Slow Burns: A Qualitative Study of Burn Pit and Toxic Exposures Among Military Veterans Serving in Afghanistan, Iraq and Throughout the Middle East. Ann Psychiatry Clin Neurosci 2021; 4:1042. [PMID: 35128459 PMCID: PMC8816568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
During deployment to the Persian Gulf War and Southwest Asia theatre of operations, Veterans often experienced various hazards, foremost being open-air burn pits and oil well fires. While over 23 presumptive conditions (ranging from brain cancer, interstitial lung disease, and lymphomas to sleep/mood disorders, depression, and cognitive impairment) have been studied in connection with their military-related exposures, there is a paucity of qualitative research on this topic. This is especially true in the context of explanatory models and health belief systems, vis-à-vis underlying social and cultural factors. The current paper provides a balanced conceptual framework (summarizing causal virtues and shortcomings) about the challenges that Veterans encounter when seeking medical care, screening assessments and subsequent treatments.
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Affiliation(s)
- Pollie Bith-Melander
- Department of Social Work, California State University, Stanislaus, Turlock, CA, USA
| | - Jack Ratliff
- Department of Medical-Surgical Oncology, James A Haley Veterans Affairs Hospital, Tampa, FL, USA,Military Exposures Team, HunterSeven Foundation, Providence, RI, USA
| | - Chelsey Poisson
- Military Exposures Team, HunterSeven Foundation, Providence, RI, USA
| | | | | | - Jimmy T Efird
- Cooperative Studies Program Epidemiology Center, Health Services Research and Development, DVAHCS, Durham, USA,Correspondence: Jimmy T Efird, Cooperative Studies Program Epidemiology Center, Health Services Research and Development, DVAHCS, Durham, NC 27705, USA, Tel: +1-650-248-8282;
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Asfaw BB, Beiersmann C, Keck V, Nikendei C, Benson-Martin J, Schütt I, Lohmann J. Experiences of psychotherapists working with refugees in Germany: a qualitative study. BMC Psychiatry 2020; 20:588. [PMID: 33308187 PMCID: PMC7733283 DOI: 10.1186/s12888-020-02996-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 12/03/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Despite a high burden of mental health problems among refugees, there is limited knowledge about effective mental health care provision for this group. Although substantial efforts in understanding the complexity of cross-cultural psychotherapy - which in the context of this study we use to refer to therapy with client and therapist of different cultural backgrounds - have been made, there remains a dearth of research exploring barriers for effective cross-cultural psychotherapy. This study aimed at narrowing this gap in knowledge by exploring major challenges encountered by psychotherapists in cross-cultural psychotherapy and strategies which have proven useful in overcoming such challenges. METHODS We employed a qualitative study design, conducting semi-structured in-depth interviews with 10 purposely selected psychotherapists working with refugees in Germany. Respondents were from varying theoretical background and had varying levels of experience. Data were analyzed using a thematic approach, following a mix of deductive and inductive coding. RESULTS Respondents reported three main challenges in their cross-cultural practice: different or unrealistic expectations of clients towards what psychotherapy would offer them; challenges grounded in different illness explanatory models; and communication challenges. In dealing with these challenges, respondents recommended psychoeducation to overcome issues related to problematic expectations towards psychotherapy; "imagining the real", identifying "counter magic" and other client-appropriate resources to deal with issues related to clients' foreign illness attributions; and translators in dealing with communication barriers, though the latter not univocally. CONCLUSIONS Results show that psychotherapy with refugees can be very successful, at least from the psychotherapist perspective, but also poses significant challenges. Our findings underline the importance of developing, testing, and institutionalizing structured and structural approaches to training psychotherapists in cross-cultural therapy at scale, to accommodate the rising mental health care need of refugees as a client group.
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Affiliation(s)
- Baye Berihun Asfaw
- Department of Psychology, College of Social Sciences and Humanities, University of Gonder, P.O. Box: 196, Gonder, Ethiopia.
| | - Claudia Beiersmann
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Verena Keck
- Department of Social and Cultural Anthropology, Goethe University Frankfurt/Main, Frankfurt, Germany
| | - Christoph Nikendei
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Janine Benson-Martin
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
- Gesundheitsamt Enzkreis, Pforzheim, Germany
| | | | - Julia Lohmann
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Jonkman LJ, Tsuchihashi K, Liu E, Lates J, Niaz Q, Rennie T; MPharm Class of 2021. Patient experiences in managing non-communicable diseases in Namibia. Res Social Adm Pharm 2020; 16:1550-7. [PMID: 32919919 DOI: 10.1016/j.sapharm.2020.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 07/30/2020] [Accepted: 08/06/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The prevalence of non-communicable diseases (NCDs) is rising in Namibia, and with it, the need for pharmacists to empower patients. This research aims to 1) identify patient-reported barriers and facilitators to managing chronic NCDs for Namibians, and 2) characterize common patient-reported medication and health-related needs of Namibians with chronic NCDs. METHODS This qualitative study used semi-structured interviews to elicit participant perspectives regarding NCDs. The study used the conceptual frameworks of the Health Belief Model, the Theory of Planned Behavior, and the Explanatory Models of Illness to identify and understand key factors necessary to develop relevant patient-centered interventions. Participants were recruited from pharmacies throughout Namibia. Data were analyzed using thematic analysis from the transcribed interviews. RESULTS A total of 23 interviews were conducted, with 20 being included in the final analysis. Themes identified included: 1) participants were motivated to seek care when they were symptomatic; 2) participants felt motivated to care for their condition to improve their own lives and their families for their family's sake; 3) participants integrated information from a variety of sources into their disease knowledge; 4) participants describe wanting to be more engaged in managing their health and wanting support to help manage their condition; 5) participants describe awareness of lifestyle changes necessary to improve health, but face many barriers to achieving them. CONCLUSION This study identified key factors that are essential for pharmacists and other health care professionals to be aware of in order to support patients who are diagnosed with an NCD. Health care providers should consider strategies to engage patients to harness their motivations, enhance health education, and create systems to reduce barriers to addressing lifestyle.
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Mayston R, Frissa S, Tekola B, Hanlon C, Prince M, Fekadu A. Explanatory models of depression in sub-Saharan Africa: Synthesis of qualitative evidence. Soc Sci Med 2019; 246:112760. [PMID: 32006814 PMCID: PMC7014569 DOI: 10.1016/j.socscimed.2019.112760] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 12/18/2019] [Accepted: 12/19/2019] [Indexed: 01/21/2023]
Abstract
Debate about the cross-cultural relevance of depression has been central to cross-cultural psychiatry and global mental health. Although there is now a wealth of evidence pertaining to symptoms across different cultural settings, the role of the health system in addressing these problems remains contentious. Depression is undetected among people attending health facilities. We carried out a thematic synthesis of qualitative evidence published in the scientific literature from sub-Saharan Africa to understand how depression is debated, deployed and described. No date limits were set for inclusion of articles. Our results included 23 studies carried out in communities, among people living with HIV, attendees of primary healthcare and with healthcare workers and traditional healers. Included studies were carried out between 1995 and 2018. In most cases, depression was differentiated from 'madness' and seen to have its roots in social adversity, predominantly economic and relationship problems, sometimes entangled with HIV. Participants described the alienation that resulted from depression and a range of self-help and community resources utilised to combat this isolation. Both spiritual and biomedical causes, and treatment, were considered when symptoms were very severe and/or other possibilities had been considered and discarded. Context shaped narratives: people already engaged with the health system for another illness such as HIV were more likely to describe their depression in biomedical terms. Resolution of depression focussed upon remaking the life world, bringing the individual back to familiar rhythms, whether this was through the mechanism of encouraging socialisation, prayer, spiritual healing or biomedical treatment. Our findings suggest that it is essential that practitioners and researchers are fluent in local conceptualisations and aware of local resources to address depression. Design of interventions offered within the health system that are attuned to this are likely to be welcomed as an option among other resources available to people living with depression.
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Affiliation(s)
- Rosie Mayston
- Global Health and Social Medicine/King's Global Health Institute, King's College London, Social Science and Public Policy, NE Wing, Bush House, 30 Aldwych, London, WC2B 4BG, UK.
| | - Souci Frissa
- Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Health Service & Population Research, King's College London, UK.
| | - Bethlehem Tekola
- Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Health Service & Population Research, King's College London, UK.
| | - Charlotte Hanlon
- Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Health Service & Population Research, King's College London, UK.
| | - Martin Prince
- Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Health Service & Population Research, King's College London, UK.
| | - Abebaw Fekadu
- CDT-Africa, Main Library Building, College of Health Sciences, Addis Ababa University, PO Box 9086, Addis Ababa, Ethiopia; Global Health & Infection Department, Brighton and Sussex Medical School, Brighton, UK.
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Bronstein JM. The cultural construction of preterm birth in the United States. Anthropol Med 2019; 27:234-241. [PMID: 31779481 DOI: 10.1080/13648470.2019.1688610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This commentary explores four features of the cultural construction of pregnancy and childbirth in the United States: risk categorization as an aspect of reproductive governance, medicalization, intensive mothering with its implications for gender stratification, and the definition of personhood as beginning at conception. The cultural construction of preterm births (those that end before gestation is complete at about 37 weeks) is interwoven with beliefs about risk in pregnancy. Health risk categories overlap with socially stigmatized characteristics and behaviors, opening sub-groups of women up to intensive surveillance and control. The belief that preterm births are preventable and treatable reinforces medical authority and rationalizes the large allocation of resources to specialty (as opposed to primary) maternal and infant care. Expectations for maternal behavior when preterm birth is threatened and when it occurs reinforce norms of intensive mothering, while the ability to keep preterm infants alive reinforces beliefs about fetal personhood. In these ways, the cultural construction of preterm birth in the U.S. holds the broader construction of pregnancy and childbirth in place by raising the stakes of deviation from norms of reproduction to matters of criminality, death, or serious disability.
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Affiliation(s)
- Janet M Bronstein
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
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Mathews M, Bhola P, Herbert H, Chaturvedi SK. Explanatory models of mental illness among family caregivers of persons in psychiatric rehabilitation services: A pilot study. Int J Soc Psychiatry 2019; 65:589-602. [PMID: 31385555 DOI: 10.1177/0020764019866228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Understanding the explanatory models of family caregivers is particularly important in interdependent contexts like India, where they often play a significant role in the help-seeking behaviours, treatment decision-making and long-term care of those diagnosed with mental illness. AIMS This study was planned to explore the diversity of explanatory models among family caregivers at a centre for recovery-oriented rehabilitation services in South India. METHODS The sample for this study included 60 family caregivers of patients referred to Psychiatric Rehabilitation Services within a tertiary-care hospital for mental health and neurosciences. Bart's Explanatory Model Inventory, including a semi-structured interview and a checklist, assessed the family caregivers' explanatory model of distress on five domains: identity, cause, timeline, consequences and control/cure/treatment. RESULTS The results indicated the coexistence of multiple causal explanatory models including psychosocial, supernatural, situational and behavioural contributors. While 36.7% of the caregivers displayed two explanatory models, 33.3% of the caregivers held three explanatory models and 16.6% of the caregivers endorsed four explanatory models. Caregivers shared their concerns about varied consequences of mental illness but less than half of them were aware of the name of the psychiatric disorder. While they accessed various forms of treatments and adjunctive supports such as prayer, medication was the most frequently used treatment method. CONCLUSIONS The findings have implications for collaborative goal setting in recovery-oriented services for persons with mental illness and their families.
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Affiliation(s)
- Manila Mathews
- 1 Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Poornima Bhola
- 1 Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Hesi Herbert
- 1 Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Santosh K Chaturvedi
- 2 Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
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Abstract
Depression is highly prevalent and the cause of considerable suffering for peoples across the globe. Case finding for depression is challenging because individuals often do not recognize the symptoms in themselves or may resist the diagnosis as a result of cultural stigma. Screening instruments, to be accurate, must be valid in the particular setting in which they are being applied, and diagnosis in primary care settings, is further made challenging because patients often present with a wide variety of somatic symptoms that could be medical. 115 women were screened for depression in this study in one community in Uganda, and 87 were found to be depressed using the SRQ-20. The cognitive impairment and decreased energy sub-scales of the SRQ-20 seemed to best differentiate for depression. We then interviewed the 87 women and found that, overwhelmingly, their complaints were somatic, and that their expectation for treatment was to receive medical tests and medications. Caregivers in primary care clinics in Uganda should know that in the reporting of their somatic symptoms patients may be trying to communicate more about themselves than just the state of their physical health; and that feelings of uselessness or of hopelessness when expressed by a patient should lead them to suspect severe mental illness since these symptoms were not found to be characteristic of the milder depression that is highly prevalent in Ugandan women.
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Affiliation(s)
- Michael Fischer
- Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, USA.
| | - Rohit Ramaswamy
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Grace Mugisha
- Kyibumba Young Women Community Development Initiative, Kisoro, Uganda
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Abstract
Asthma is among the most common chronic diseases worldwide and is a significant contributor to the global health burden, highlighting the urgent need for primary prevention. This article outlines several practical and conceptual challenges that accompany primary prevention efforts. It advocates for improved predictive modeling to identify those at high-risk of developing asthma using automated algorithms within electronic medical records systems and explanatory modeling to refine understanding of causal pathways. Understanding the many issues that are likely to affect the success of primary prevention efforts helps the community of individuals invested in asthma prevention organize efforts and maximize their impact.
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Carter L, Read J, Pyle M, Morrison A. "I Believe I Know Better Even than the Psychiatrists What Caused It": Exploring the Development of Causal Beliefs in People Experiencing Psychosis. Community Ment Health J 2018; 54:805-813. [PMID: 29368133 PMCID: PMC6061113 DOI: 10.1007/s10597-017-0219-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 12/26/2017] [Indexed: 11/21/2022]
Abstract
This study aimed to describe the causal beliefs of individuals experiencing psychosis, specifically exploring how they are developed and maintained. Individuals with experience of psychosis were recruited from mental health services for in-depth interviews. A thematic analysis was used to analyse transcripts and key themes were identified. Fifteen interviews were conducted. Individuals were engaged in the process of exploring explanations for their experiences and reported sophisticated models of causation. Participants described a change in their beliefs, with the cause of their experiences not immediately clear. Individuals generated their models via external (family, professionals) and internal (evaluative, positive affect) processes and reported differing levels of conviction in relation to their beliefs. Clinicians should take the opportunity to explore the causal beliefs of their service-users, as they are able to provide intelligent and thoughtful explanatory models. In particular, clinicians should be aware of the emotional impact of different aetiological models and their personal role in the development of a client's beliefs.
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Affiliation(s)
- Lucy Carter
- School of Psychological Sciences, The University of Manchester, Manchester, M13 9PL, UK.
- Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK.
| | - John Read
- Clinical Psychology, University of East London, Stratford Campus, 1 Salway Road, Stratford, London, E15 1NF, UK
| | - Melissa Pyle
- Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
| | - Anthony Morrison
- School of Psychological Sciences, The University of Manchester, Manchester, M13 9PL, UK
- Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
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Kpobi L, Swartz L, Keikelame MJ. Ghanaian traditional and faith healers' explanatory models for epilepsy. Epilepsy Behav 2018; 84:88-92. [PMID: 29754110 DOI: 10.1016/j.yebeh.2018.04.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 04/22/2018] [Accepted: 04/23/2018] [Indexed: 01/07/2023]
Abstract
Epilepsy is the most common neurological condition in sub-Saharan Africa. A significant number of people with epilepsy in low- and middle-income countries do not receive formal biomedical care. They utilize the services of various traditional and alternative medicine practitioners. However, there is relatively little information about the beliefs and methods of alternative healthcare providers about epilepsy in many African countries. Using explanatory models of illness framework, we interviewed thirty-six traditional and faith healers in Ghana on their beliefs and perceptions about epilepsy, as well as how they would treat epilepsy. The healers' beliefs about the nature of epilepsy were reflected in the labels they assigned to the condition. These indicated a belief in the influence of the moon in epilepsy. Furthermore, the participants held multiple, simultaneous explanatory models of causes for epilepsy, including biological, social, and supernatural causes. Epilepsy was also considered to have serious social implications for patients, especially for women. Finally, their treatment methods involved a range of herbal and spiritual practices. These varied based on the identified cause of the condition, as well as the orientation of the healer. We discuss these findings with reference to their implications for potential collaboration between biomedical and alternative healthcare systems.
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Affiliation(s)
- Lily Kpobi
- Department of Psychology, Stellenbosch University, South Africa.
| | - Leslie Swartz
- Department of Psychology, Stellenbosch University, South Africa
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Sarudiansky M, Lanzillotti AI, Areco Pico MM, Tenreyro C, Scévola L, Kochen S, D'Alessio L, Korman GP. What patients think about psychogenic nonepileptic seizures in Buenos Aires, Argentina: A qualitative approach. Seizure 2017; 51:14-21. [PMID: 28755568 DOI: 10.1016/j.seizure.2017.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 07/10/2017] [Accepted: 07/12/2017] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To analyse the methods of reasoning with regard to patients' experiences of living with psychogenic nonepileptic seizures (PNES) in Buenos Aires, Argentina. METHOD A qualitative approach using semi-structured interviews was used to gain an in-depth and contextual understanding of the perspectives of five patients with PNES. Data collection and analysis were followed by an inductive and interpretive approach informed by the principles of thematic analysis. RESULTS Explanatory models and prototypes were identified from the patients' narratives. Four patients related their suffering regarding psychosocial causes -family conflicts, sexual harassment, and life changes, among others-. Hereditary and organic hypotheses appeared to be unspecific. Folk explanations were common to all participants (magic, witchcraft, energetic causes). Four patients used the term epilepsy as an illness prototype, focusing on seizures and the use of antiepileptic drugs. Three of them also compared their illness to other people's "attacks" (heart attacks, panic attacks, nervous breakdown). Only one of them referred to someone who was suspected of having epilepsy. CONCLUSION Patients' psychosocial explanatory models are different from the results of previous studies because these studies indicate that most patients support somatic explanations. Patients also use folk explanations related to traditional medicine, which highlights the interpersonal aspects of the disease. Doctor-patient communication is essential for a correct understanding of PNES, resulting in better outcomes. It could also help to reduce the cultural distance between professionals and patients, leading to narrowing inequalities present in multicultural healthcare services.
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Affiliation(s)
- Mercedes Sarudiansky
- CAEA, CONICET, Buenos Aires, Argentina; Epilepsy Centre, Ramos Mejía and El Cruce Hospital, Argentina; Facultad de Psicología, Universidad de Buenos Aires, Argentina.
| | - Alejandra Inés Lanzillotti
- CAEA, CONICET, Buenos Aires, Argentina; Epilepsy Centre, Ramos Mejía and El Cruce Hospital, Argentina; Facultad de Psicología, Universidad de Buenos Aires, Argentina
| | - María Marta Areco Pico
- CAEA, CONICET, Buenos Aires, Argentina; Epilepsy Centre, Ramos Mejía and El Cruce Hospital, Argentina; Facultad de Psicología, Universidad de Buenos Aires, Argentina
| | | | - Laura Scévola
- ENyS, CONICET, Buenos Aires, Argentina; Epilepsy Centre, Ramos Mejía and El Cruce Hospital, Argentina; Mental Health Center, Ramos Mejía Hospital, Buenos Aires, Argentina
| | - Silvia Kochen
- ENyS, CONICET, Buenos Aires, Argentina; Epilepsy Centre, Ramos Mejía and El Cruce Hospital, Argentina
| | - Luciana D'Alessio
- ENyS, CONICET, Buenos Aires, Argentina; Epilepsy Centre, Ramos Mejía and El Cruce Hospital, Argentina
| | - Guido Pablo Korman
- CAEA, CONICET, Buenos Aires, Argentina; Epilepsy Centre, Ramos Mejía and El Cruce Hospital, Argentina; Facultad de Psicología, Universidad de Buenos Aires, Argentina
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Cohen A, Padmavati R, Hibben M, Oyewusi S, John S, Esan O, Patel V, Weiss H, Murray R, Hutchinson G, Gureje O, Thara R, Morgan C. Concepts of madness in diverse settings: a qualitative study from the INTREPID project. BMC Psychiatry 2016; 16:388. [PMID: 27829384 PMCID: PMC5103598 DOI: 10.1186/s12888-016-1090-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 10/25/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In order to facilitate case identification of incident (untreated and recent onset) cases of psychosis and controls in three sites in India, Nigeria and Trinidad, we sought to understand how psychoses (or madness) were conceptualized locally. The evidence we gathered also contributes to a long history of research on concepts of madness in diverse settings. METHODS We conducted focus group discussions and individual interviews to collect information about how informants in each site make sense of and respond to madness. A coding framework was developed and analyses of transcripts from the FGDs and interviews were conducted. RESULTS Analyses suggest the following: a) disturbed behaviors are the primary sign of madness; b) madness is attributed to a wide range of causes; and, c) responses to madness are dictated by cultural and pragmatic factors. These findings are congruent with similar research that has been conducted over the past 50 years. CONCLUSIONS The INTREPID research suggests that concepts about madness share similar features across diverse settings: a) terms for madness are often derived from a common understanding that involves disruptions in mental processes and capacities; b) madness is recognized mostly by disruptive behaviours or marked declines in functioning; c) causal attributions are varied; and, d) help-seeking is a complex process.
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Affiliation(s)
- Alex Cohen
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Maia Hibben
- Department of Psychiatry, University of the West Indies, St Augustine, Trinidad
| | - Samuel Oyewusi
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | - Sujit John
- Schizophrenia Research Foundation, Chennai, India
| | - Oluyomi Esan
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | - Vikram Patel
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen Weiss
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Robin Murray
- Psychosis Studies Department, Institute of Psychiatry, King’s College London, London, UK ,National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, London, UK
| | - Gerard Hutchinson
- Department of Psychiatry, University of the West Indies, St Augustine, Trinidad
| | - Oye Gureje
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | | | - Craig Morgan
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK. .,Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK.
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Brown SA, García AA, Brown A, Becker BJ, Conn VS, Ramírez G, Winter MA, Sumlin LL, Garcia TJ, Cuevas HE. Biobehavioral determinants of glycemic control in type 2 diabetes: A systematic review and meta-analysis. Patient Educ Couns 2016; 99:1558-67. [PMID: 27036083 PMCID: PMC5028237 DOI: 10.1016/j.pec.2016.03.020] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 03/17/2016] [Accepted: 03/19/2016] [Indexed: 05/21/2023]
Abstract
OBJECTIVES To conduct a model-driven meta-analysis of correlational research on psychological and motivational predictors of diabetes outcomes, with adherence factors as mediators. METHODS A comprehensive literature search of published and unpublished studies located a sample of 775 individual correlational or predictive studies reported across 739 research reports. RESULTS Results varied according to the outcome variable included in the regression models. Depression had a larger negative effect on adherence to physical activity than on dietary adherence. Coping and self-efficacy were strongly related to dietary adherence, which was strongly related to improved glycemic control. Medication adherence was related to glycosylated hemoglobin, whereas medications and self-monitoring were related to fasting blood glucose. Adding appointment keeping to the models did not significantly alter the results. CONCLUSION Self-efficacy was the most consistent predictor of all adherence behaviors and dietary adherence was the most significant predictor of HbA1c. Physical activity was the most predictive factor of BMI and glucose self-monitoring the most predictive of FBG. PRACTICE IMPLICATIONS Metabolic control is a primary goal in T2DM, so the best pathway to attaining that goal appears to be an emphasis on self-efficacy and dietary adherence.
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Affiliation(s)
- Sharon A Brown
- The University of Texas at Austin, School of Nursing, Austin, TX, USA.
| | | | - Adama Brown
- The University of Texas at Austin, School of Nursing, Austin, TX, USA
| | - Betsy J Becker
- Florida State University, College of Education, Tallahassee, FL, USA
| | - Vicki S Conn
- University of Missouri, Sinclair School of Nursing, Columbia, MO, USA
| | - Gilbert Ramírez
- Texas A&M Health Science Center, School of Public Health, College Station, TX, USA
| | - Mary A Winter
- The University of Texas at Austin, School of Nursing, Austin, TX, USA
| | - Lisa L Sumlin
- The University of Texas at Austin, School of Nursing, Austin, TX, USA
| | - Theresa J Garcia
- Texas A&M-Corpus Christi, School of Nursing, Corpus Christi, TX, USA
| | - Heather E Cuevas
- The University of Texas at Austin, School of Nursing, Austin, TX, USA
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Leavey G, Loewenthal K, King M. Locating the Social Origins of Mental Illness: The Explanatory Models of Mental Illness Among Clergy from Different Ethnic and Faith Backgrounds. J Relig Health 2016; 55:1607-22. [PMID: 26874526 PMCID: PMC4956700 DOI: 10.1007/s10943-016-0191-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Clergy have historically provided 'healing' through various spiritual and medical modalities and even in modern, developed welfare economies they may still be an important help-seeking resource. Partnerships between religion and psychiatry are regularly advocated, but there is scant research on clergy explanatory models of illness. This paper aimed to explore their relationship with psychiatry and to examine how clergy in various faith groups conceptualised mental health problems. In this qualitative study using in-depth interviews, these issues were explored with 32 practising clergy in the UK from a range of different Christian, Muslim and Jewish faith organisations and ethnic backgrounds. This paper presents findings related to clergy explanatory models of mental illness and, in particular, how the social factors involved in causation are tinged with spiritual influences and implications, and how the meanings of mental distress assume a social and moral significance in distinctive localised matters.
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Affiliation(s)
- Gerard Leavey
- />Bamford Centre for Mental Health and Wellbeing, Ulster University, Magee Campus, Northlands Road, Derry-Londonderry, BT48 7JL Northern Ireland, UK
| | - Kate Loewenthal
- />Department of Psychology, Royal Holloway, University of London, Egham, UK
| | - Michael King
- />Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
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Habte BM, Kebede T, Fenta TG, Boon H. Explanatory models of adult patients with type 2 diabetes mellitus from urban centers of central Ethiopia. BMC Res Notes 2016; 9:441. [PMID: 27623807 PMCID: PMC5022171 DOI: 10.1186/s13104-016-2248-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 09/07/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Type 2 diabetes, which is increasing as a public health problem in the low resource settings of Africa has been associated with the high prevalence of micro-vascular complications and increasing levels of macro-vascular complications. There is evidence from the developed world that understanding patient perceptions of chronic illness is important to design effective strategies for helping patients manage these conditions. This study utilized Kleinman's model to explore the illness perceptions of type 2 diabetes patients attending treatment in Addis Ababa and Butajira (Ethiopia) and better understand how they manage their illness. DESIGN Qualitative interviews were conducted to elicit the explanatory models of purposively sampled type 2 diabetes patients attending treatment in three hospitals in central Ethiopia until saturation of key emerging themes was achieved. Analysis of interview transcripts was guided by Kleinman's model. RESULTS A total of 39 participants, 24 from Addis Ababa and the rest from Butajira took part in the study. This study revealed that patients' explanatory models were informed by both the traditional and biomedical models with emotional distress evident in some of the participants. The traditional model seemed to reflect the strong religious and cultural influences for the majority of study participants. The findings also revealed that symptoms played significant roles in how patients viewed their illness including assessment of its severity. Most were uncertain about the cause of their illness, with those expressing certainty citing factors over which they believed they had little or no control. This may have contributed to the perceptions about the use of religious healing and traditional medicines in a complementary or alternative manner to the biomedical regimen which could affect their adherence to recommended regimens and their health outcomes. CONCLUSION This study suggests the need for a strong diabetes care program that is sensitive to patients' experiences of their illness including emotional distress. Individuals providing the diabetes care should consider local and individual contexts and strive to make their approach patient-centered and engage active participation of patients. There appears to be a need for better training of health providers in different areas including health communications and the fundamentals of mental healthcare.
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Affiliation(s)
- Bruck M Habte
- School of Pharmacy, College of Health Sciences (CHS), Addis Ababa University (AAU), P. O. Box 1176, Addis Ababa, Ethiopia.
| | - Tedla Kebede
- School of Medicine, CHS, AAU, P. O. Box 1176, Addis Ababa, Ethiopia
| | - Teferi G Fenta
- School of Pharmacy, College of Health Sciences (CHS), Addis Ababa University (AAU), P. O. Box 1176, Addis Ababa, Ethiopia
| | - Heather Boon
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street (Room 514), Toronto, ON, M5S 3M2, Canada
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Abstract
Research into explanatory models of disease and illness typically explores people's conceptual understanding, and emphasizes differences between patient and provider models. However, the explanatory models framework of etiology, time and mode of onset of symptoms, pathophysiology, course of sickness, and treatment is built on categories characteristic of biomedical understanding. It is unclear how well these map onto people's lived experience of illness, and to the extent they do, how they translate. Scholars have previously studied the experience of people living with HIV through the lenses of stigma and identity theory. Here, through in-depth qualitative interviews with 32 people living with HIV in the northeast United States, we explored the experience and meanings of living with HIV more broadly using the explanatory models framework. We found that identity reformation is a major challenge for most people following the HIV diagnosis, and can be understood as a central component of the concept of course of illness. Salient etiological explanations are not biological, but rather social, such as betrayal, or living in a specific cultural milieu, and often self-evaluative. Given that symptoms can now largely be avoided through adherence to treatment, they are most frequently described in terms of observation of others who have not been adherent, or the resolution of symptoms following treatment. The category of pathophysiology is not ordinarily very relevant to the illness experience, as few respondents have any understanding of the mechanism of pathogenesis in HIV, nor much interest in it. Treatment has various personal meanings, both positive and negative, often profound. For people to engage successfully in treatment and live successfully with HIV, mechanistic explanation is of little significance. Rather, positive psychological integration of health promoting behaviors is of central importance.
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Abstract
Studies on reproductive technologies often examine women's reproductive lives in terms of choice and control. Drawing on 48 accounts of procreative experiences of religiously devout Jewish women in Israel and the US, we examine their attitudes, understandings and experiences of pregnancy, reproductive technologies and prenatal testing. We suggest that the concept of hishtadlut-"obligatory effort"-works as an explanatory model that organizes Haredi women's reproductive careers and their negotiations of reproductive technologies. As an elastic category with negotiable and dynamic boundaries, hishtadlut gives ultra-orthodox Jewish women room for effort without the assumption of control; it allows them to exercise discretion in relation to medical issues without framing their efforts in terms of individual choice. Haredi women hold themselves responsible for making their obligatory effort and not for pregnancy outcomes. We suggest that an alternative paradigm to autonomous choice and control emerges from cosmological orders where reproductive duties constitute "obligatory choices."
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Forsyth C. Controlled but not cured: Structural processes and explanatory models of Chagas disease in tropical Bolivia. Soc Sci Med 2015; 145:7-16. [PMID: 26432176 DOI: 10.1016/j.socscimed.2015.09.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 09/13/2015] [Accepted: 09/14/2015] [Indexed: 11/23/2022]
Abstract
Dressler (2001:456) characterizes medical anthropology as divided between two poles: the constructivist, which focuses on the "meaning and significance that events have for people," and the structuralist, which emphasizes socioeconomic processes and relationships. This study synthesizes structuralist and constructivist perspectives by investigating how structural processes impact explanatory models of Chagas disease in a highly endemic area. The research took place from March-June 2013 through the Centro Medico Humberto Parra, a non-profit clinic servicing low income populations in Palacios, Bolivia and surrounding communities. Semistructured interviews (n = 68) and consensus analysis questionnaires (n = 48) were administered to people dealing with Chagas disease. In the interview narratives, respondents link Chagas disease with experiences of marginalization and rural poverty, and describe multilayered impediments to accessing treatment. They often view the disease as incurable, but this reflects inconsistent messages from the biomedical system. The consensus analysis results show strong agreement on knowledge of the vector, ethnomedical treatment, and structural factors related to Chagas disease. In interpreting Chagas disease, respondents account for the structural factors which place them at risk and impede access to care.
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Bhikha A, Farooq S, Chaudhry N, Naeem F, Husain N. Explanatory models of psychosis amongst British South Asians. Asian J Psychiatr 2015; 16:48-54. [PMID: 26232352 DOI: 10.1016/j.ajp.2015.05.042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 05/25/2015] [Accepted: 05/26/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE A strong interest in the understanding, exploring, and extracting explanatory models of psychosis has recently arisen. Explanatory models (EMs) offer justifications and propose explanations when coping with and treating illnesses. Therefore, they may be important predictors of clinical outcome. Explanatory models of psychosis have been explored in many non-Western countries. However, very little research has examined EMs of psychosis in the UK. We therefore, aimed to elicit and describe explanatory models of psychosis amongst British South Asians, using both quantitative and qualitative methods. METHOD EMs of psychosis were examined using the Short Explanatory Model Interview (SEMI) in a cross-sectional sample of 45 patients. RESULTS Most patients (55.5%) attributed their illness to supernatural causes. Few patients cited a biological (4.4%) cause. Majority of patients held dual EMs of psychosis (77.7%), combining prescribed medication and seeing a traditional healer as a treatment method. Duration of Untreated Psychosis (DUP) was not significantly associated with EMs of psychosis. CONCLUSION The results suggest that patients hold multi-explanatory models in order to make sense of their illness and these stem from deep rooted traditional beliefs. This highlights the importance of educational intervention, culturally adapted psychological interventions and possibly working together with traditional healers in the UK to provide a positive support system. Further work is required in order to fully understand the relationship between EMs of psychosis and DUP.
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Affiliation(s)
- Aqeela Bhikha
- University of Manchester, Institute of Brain, Behaviour, and Mental Health, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, United Kingdom.
| | - Saeed Farooq
- Staffordshire University & Consultant Psychiatrist Black County Partnership, NHS Foundation Trust, Staffordshire University, BL167, Blackheath Lane, Beaconside, ST18 0AD, Staffordshire, United Kingdom.
| | - Nasim Chaudhry
- Greater Manchester West Mental Health Foundation Trust and Honorary Leturer, University of Manchester, Meadowbrook Psychiatric Unit, Stott Lane, Salford M68HG, United Kingdom.
| | - Farooq Naeem
- Queens University, Kingston, & AMHS-KFLA, 385 Princess Street, Kingston, ON, Canada, K7L 1B9.
| | - Nusrat Husain
- University of Manchester, Institute of Brain, Behaviour, and Mental Health, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, United Kingdom.
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Abstract
The new R package flirt is introduced for flexible item response theory (IRT) modeling of psychological, educational, and behavior assessment data. flirt integrates a generalized linear and nonlinear mixed modeling framework with graphical model theory. The graphical model framework allows for efficient maximum likelihood estimation. The key feature of flirt is its modular approach to facilitate convenient and flexible model specifications. Researchers can construct customized IRT models by simply selecting various modeling modules, such as parametric forms, number of dimensions, item and person covariates, person groups, link functions, etc. In this paper, we describe major features of flirt and provide examples to illustrate how flirt works in practice.
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Aggarwal NK, Balaji M, Kumar S, Mohanraj R, Rahman A, Verdeli H, Araya R, Jordans MJD, Chowdhary N, Patel V. Using consumer perspectives to inform the cultural adaptation of psychological treatments for depression: a mixed methods study from South Asia. J Affect Disord 2014; 163:88-101. [PMID: 24836093 PMCID: PMC4037874 DOI: 10.1016/j.jad.2014.03.036] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 03/14/2014] [Accepted: 03/17/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Integrating consumer perspectives in developing and adapting psychological treatments (PTs) can enhance their acceptability in diverse cultural contexts. OBJECTIVE To describe the explanatory models (EMs) of depression in South Asia with the goal of informing the content of culturally appropriate PTs for this region. METHODS Two methods were used: a systematic review of published literature on the EMs of depression in South Asia; and in-depth interviews with persons with depression and family caregivers in two sites in India. Findings from both were analysed independently and then triangulated. RESULTS There were 19 studies meeting our inclusion criteria. Interviews were conducted with 27 patients and 10 caregivers. Findings were grouped under four broad categories: illness descriptions, perceived impact, causal beliefs and self-help forms of coping. Depression was characterised predominantly by somatic complaints, stress, low mood, and negative and ruminative thoughts. Patients experienced disturbances in interpersonal relationships occupational functioning, and stigma. Negative life events, particularly relationship difficulties, were perceived as the main cause. Patients mostly engaged in distracting activities, religious practices, and received support from family and friends to cope with the illness. LIMITATIONS The primary data are entirely from India but the studies from the literature review covering South Asia are consistent with these findings. This study also does not include literature in local languages or explore how consumer perspectives change over time. CONCLUSIONS EMs can inform cultural adaptations to PTs for depression in South Asia by defining target outcomes, content for psycho-education, and culturally appropriate treatment strategies.
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Affiliation(s)
- Neil Krishan Aggarwal
- Columbia University, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 11, New York, NY 10032, USA.
| | - Madhumitha Balaji
- Parivartan Trust, Plot no. 20, Vijaya Villa Survey, No. 235A, Sanjay Park, Lane no. 1, Lohgaon Airport Road, Pune 411014, India; Sangath Centre, 841/1 Alto-Porvorim, Sangath, Goa 403521, India.
| | - Shuba Kumar
- Samarth, No. 100, Warren Road, Mylapore, Chennai 600004, India.
| | - Rani Mohanraj
- Samarth, No. 100, Warren Road, Mylapore, Chennai 600004, India.
| | - Atif Rahman
- University of Liverpool, Institute of Psychology, Health & Society, Child Mental Health Unit, Alder Hey Children׳s NHS Foundation Trust, Mulberry House, Eaton Road, Liverpool L12 2AP, UK.
| | - Helena Verdeli
- Department of Counselling and Clinical Psychology, Teachers College, Columbia University, 525W 120th Street, New York City, NY 10027, USA.
| | - Ricardo Araya
- Academic Unit of Psychiatry, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK.
| | - M J D Jordans
- Health Net TPO, Lizzy Ansinghstraat 163, 1073 RG Amsterdam, The Netherlands; Center for Global Mental Health, Institute of Psychiatry, King's College London, Box P029, De Crespigny Park, London SE5 8AF, UK.
| | - Neerja Chowdhary
- Sangath Centre, 841/1 Alto-Porvorim, Sangath, Goa 403521, India.
| | - Vikram Patel
- Sangath Centre, 841/1 Alto-Porvorim, Sangath, Goa 403521, India; London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7H, UK.
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van Duijl M, Kleijn W, de Jong J. Unravelling the spirits' message: a study of help-seeking steps and explanatory models among patients suffering from spirit possession in Uganda. Int J Ment Health Syst 2014; 8:24. [PMID: 24940355 PMCID: PMC4060147 DOI: 10.1186/1752-4458-8-24] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 05/27/2014] [Indexed: 11/25/2022] Open
Abstract
As in many cultures, also in Uganda spirit possession is a common idiom of distress associated with traumatic experiences. In the DSM-IV and -5, possession trance disorders can be classified as dissociative disorders. Dissociation in Western countries is associated with complicated, time-consuming and costly therapies. Patients with spirit possession in SW Uganda, however, often report partial or full recovery after treatment by traditional healers. The aim of this study is to explore how the development of symptoms concomitant help-seeking steps, and explanatory models (EM) eventually contributed to healing of patients with spirit possession in SW Uganda. Illness narratives of 119 patients with spirit possession referred by traditional healers were analysed using a mixed-method approach. Treatments of two-thirds of the patients were unsuccessful when first seeking help in the medical sector. Their initially physical symptoms subsequently developed into dissociative possession symptoms. After an average of two help-seeking steps, patients reached a healing place where 99% of them found satisfactory EM and effective healing. During healing sessions, possessing agents were summoned to identify themselves and underlying problems were addressed. Often-mentioned explanations were the following: neglect of rituals and of responsibilities towards relatives and inheritance, the call to become a healer, witchcraft, grief, and land conflicts. The results demonstrate that traditional healing processes of spirit possession can play a role in restoring connections with the supra-, inter-, intra-, and extra-human worlds. It does not always seem necessary to address individual traumatic experiences per se, which is in line with other research in this field. The study leads to additional perspectives on treatment of trauma-related dissociation in Western countries and on developing effective mental health services in low -and middle-income countries.
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Affiliation(s)
- Marjolein van Duijl
- Netherlands Institute for Forensic Psychiatry, The Hague, The Netherlands ; Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Wim Kleijn
- Leiden University Medical Center, Leiden, The Netherlands ; Centrum '45, Oegstgeest, The Netherlands
| | - Joop de Jong
- Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, The Netherlands ; Boston University School of Medicine, Boston, USA
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Johnson S, Sathyaseelan M, Charles H, Jacob KS. Predictors of disability: a 5-year cohort study of first-episode schizophrenia. Asian J Psychiatr 2014; 9:45-50. [PMID: 24813036 DOI: 10.1016/j.ajp.2014.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 01/02/2014] [Accepted: 01/08/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND There is a dearth of information about the predictors of disability in schizophrenia from low and middle-income countries. This study attempted to investigate the impact of socio-demographic and clinical variables on disability in a cohort of first episode schizophrenia. METHOD Patients diagnosed to have DSM IV schizophrenia (n=131) were assessed prospectively for psychopathology, functioning, insight and explanatory models of illness at baseline, 6, 12 and 60 months using standard instruments. Disability was assessed at 5 years. Multiple linear regression was employed to adjust for common confounders. RESULTS We could follow-up 95 (72.5%) patients. Sixty-five of these patients (68.4%) achieved remission. Disability scores at 5 years were associated negatively with episodic nature of illness at baseline, functional assessments at 6 and 12 months and return to pre-morbid level function. Disability correlated positively with psychopathology at 6 and 12 months and time spent in psychotic episodes. It was also associated with psychopathology, remission, insight and patient perspectives at the 5th year cross-sectional evaluation. While employment status at recruitment was not associated with disability, it was associated with unemployment at follow-up. CONCLUSIONS Disability at 5 years was associated with illness variables - episodic nature of illness at baseline, psychopathology and functioning, duration in psychotic episode and return to pre-morbid function. Patient perspectives about their illness (insight and patient explanatory models) were only associated cross-sectionally at 60 months but not earlier and are more suggestive of a coping response rather than being predictive of outcome. The relationship between unemployment and disability suggests that they are products of the same disease process.
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Affiliation(s)
- Shanthi Johnson
- College of Nursing, Christian Medical College, Vellore 632004, India
| | | | - Helen Charles
- College of Nursing, Christian Medical College, Vellore 632004, India
| | - K S Jacob
- Christian Medical College, Vellore 632002, India.
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Keikelame MJ, Swartz L. A lay carer's story about epilepsy in an urban South African context: they call it an illness of falling or an illness of fitting because a person shakes and eventually falls. Epilepsy Behav 2013; 28:512-8. [PMID: 23838162 DOI: 10.1016/j.yebeh.2013.05.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 05/16/2013] [Accepted: 05/21/2013] [Indexed: 02/05/2023]
Abstract
In South Africa, epilepsy is poorly understood and managed. The different cultural understandings and terms used to explain the condition across the diverse population groups exacerbate this problem. In this article, we describe the findings from a single story about epilepsy which we elicited through a semistructured interview guide in the respondents' natural setting. We used Kleinman and Benson's mini-ethnographic questions to explore the lay carer's explanatory models about epilepsy. Our respondent had different descriptors for epilepsy which include 'an illness of falling', 'an illness of fitting', and 'a thing'. His explanatory models concerning epilepsy were predominantly sociocultural, psychological, economical, and political in nature and were supported by personal examples from his past and present experiences. Key to this man's story is the reality of a strong cultural base of understanding epilepsy, with the added reality of an urbanized world in which people feel alienated from one another and do not necessarily share the same cultural beliefs and practices. Instead of viewing understandings of epilepsy as either 'traditional' or 'western', community-based health promotion interventions must therefore recognize both cultural issues and urban realities and should also incorporate approaches that foster a common ground for patients and carers with very diverse views. The findings of this one interview cannot be generalized but have implications for managing epilepsy in an urban African context.
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Affiliation(s)
- Mpoe Johannah Keikelame
- Primary Health Care Directorate, Faculty of Health Sciences, University of Cape Town, South Africa.
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