Transcultural Psychiatry最新文献

Clear recommendations for how to best adapt mental health services for adolescents with a background as asylum seekers and refugees are lacking. This study therefore explored healthcare professionals' experiences and perspectives on mental health needs of these groups of youth in Norway. The objectives were to explore healthcare professionals' perspectives on what is needed for adolescents with status as asylum seekers or refugees to seek professional help for mental health problems and what is important for them to experience the offered help as beneficial. A qualitative interview study was carried out to explore the perspectives of healthcare professionals (n = 11) in primary and secondary healthcare settings. Systematic text condensation was used for data analysis. Four themes were developed through the study: (a) culturally sensitive and adapted services; (b) low threshold and outreach services; (c) building a trusting relationship; and (d) user involvement. The study provides a constructivist understanding of cultural competence including several suggestions for how to overcome barriers to service use among adolescents who have a background as asylum seekers or refugees. Some of the recommendations include an ongoing collaboration with youth and their families to better understand their culture; healthcare professionals who acquire cultural competence, practice cultural humility and are mindful of their own cultural backgrounds. There should be comprehensive education and training programmes for healthcare professionals. Services should be easily accessible with simplified referral procedures and arena flexibility. Skilled interpreters should be used, including cultural interpreters. Shared decision-making should be used to actively engage youth in their treatment.

American Indian and Alaska Native (AI/AN) communities face significant social, economic, and health disparities rooted in historical traumas stemming from colonization. These disparities manifest in disproportionate rates of poverty, unemployment, and early mortality among AI/AN populations. High rates of premature deaths contribute to a persistent cycle of grief and loss, perpetuating mental and physical health problems. The current study explores the relationships between grief, historical trauma, and psychological and physical health outcomes among AI/AN individuals who have experienced the loss of a loved one. A cross-sectional survey was conducted with 576 AI adults, measuring complicated grief, adaptive grief, historical trauma, anxiety, depression, alcohol use problems, sleep health, and physical health. Cluster analysis revealed four distinct groups based on levels of complicated grief and historical trauma. Results indicated that higher levels of complicated grief and historical trauma were associated with worse mental and physical health outcomes. Moreover, individuals living on reservations reported higher levels of loss and historical trauma. Adaptive grief remained consistent across groups, suggesting a stable coping mechanism irrespective of grief severity. Findings underscore the need for interventions addressing grief and historical trauma to improve overall health outcomes in AI/AN communities.

In Canada, mental health disparities persist among racialized populations, including Black, Indigenous and other people of color. A major barrier to equitable care is the lack of adequate training of mental health professionals on racial issues. To address this unmet need, Cénat and colleagues introduced the Providing Antiracist Mental Health Care online training course. This contains five modules addressing: (a) awareness of racial issues, (b) assessment adapted to the needs of racialized individuals, (c) a humanistic approach to medication management, (d) treatment approaches for issues related to racism, and (e) providing tailored antiracist mental healthcare to children, adolescents, and families from racialized communities. This article discusses the implementation of this training among mental health providers in a school board in Ontario, Canada (n = 27), assessing changes in participants' multicultural awareness, knowledge, and skills at pre-, post-, and follow-up timepoints. The results show the ability of the Providing Antiracist Mental Health Care training course to effectively enhance multicultural awareness (F(2, 21) = 10.52, p < .001), knowledge (F(2, 21) = 11.88, p < .001) and skills (F(2, 21) = 5.21, p = .014) among mental health providers in ethnically diverse schools. The total score improved significantly (F(2, 20) = 12.17, p < .001) from pre-test to post-test, and follow-up, and no significant decrement from the post-test to follow-up was observed (M = 2.81, SD = 0.16; p = .861). This study brings evidence supporting the need for sustained and comprehensive antiracist training initiatives to foster racial equity in mental health and improve outcomes in care for racialized individuals.

This is a report of psychometric testing of the modified Multidimensional Acculturative Stress inventory (MASI) on Asian Americans. The MASI, initially developed as a 36-item measure to assess acculturative stress within individuals of Mexican origin and other Latinos in the United States, was modified for use with Asian Americans. Acculturative stress is defined for this measure as a multifaceted construct comprising four factors: English competency pressure, Asian language competency pressure, pressure to acculturate, and pressure against acculturation. Participants were recruited through social media using a purposive non-random sampling technique. We employed an instrument validation design, conducting a cross-sectional Qualtrics survey, including demographic characteristics and the modified MASI. The psychometric analysis used the model congeneric structure with confirmatory factor analysis and internal consistency reliability assessment. A total of 337 participants took part in the study (7% Asian Indian, 27% Chinese, 13% Vietnamese, 13% Korean, 7% Filipino, 18% Japanese, and 16% other ethnicities [Hmong, Thai, Lao, Cambodian]). After the elimination of one item (i.e., I have a hard time understanding others when they speak English) because of its non-significant contribution, the congeneric model (35-item) demonstrated a good fit to the data. Item loadings for the remaining items ranged from .29 to .80 and were statistically significant (p < .05). All subdomains exhibited acceptable internal consistency, with Cronbach's alpha ranging from .74 to .79 and omega coefficients ranging from .80 to .84. Our study findings affirm the suitability of the modified 35-item MASI as a valid and reliable instrument for measuring acculturative stress within the Asian American population.

Arab Americans are one of the largest ethnic minority groups in the United States. The mental health of Arab Americans and their opinions on mental health, however, remain understudied despite higher than average rates of mental illness and lower rates of treatment. Culturally-mediated conceptualizations of mental illness may generate stigma, contributing to disparities in treatment. This study aimed to assess the attitudes and perspectives of Arab Americans regarding mental illness in order to address barriers to treatment. Using an anonymous bilingual Qualtrics survey, we collected data from Arab and non-Arab participants (N = 294; ages 18+) on their conceptualizations of the causes of mental illness and on their stigma towards mental illness and mental health treatments. Compared to non-Arabs, Arab participants reported higher average mental illness stigma and were more likely to rate psychiatric medications as addictive and unhelpful. Among Arabs, being Christian, male, and older (>29 years old) were each associated with higher stigma. Arabs were less likely than non-Arabs to endorse biological explanations for mental illness. These are among the first findings to describe mental illness stigma and conceptualizations of mental health in the Arab American population and may inform future community interventions providing culturally competent care to Arab Americans.

Children of migrants are often exposed to more than one language from an early age. The Avicenne ELAL^© test has been created to better assess language skills, avoid misdiagnosing learning disabilities, and inform early interventions. Plurilingual children aged 3.5 to 6.5 take the test in their mother tongues, with an interpreter's assistance. The test comprises three scales: Comprehension, Expression, and Storytelling. The objectives of this study were to describe steps of the transcultural validation of the Avicenne ELAL^© for the Soninke culture and language, both for children living in a monolingual environment in Mauritania and for migrant children living in a multilingual environment in France; to compare the performance of these two groups; and to explore its qualitative use in studying language pathways among bilingual and plurilingual children. A total of 71 children participated in this study in Mauritania (n = 25) and France (n = 46). The Avicenne ELAL^©, a 30-minute plurilingual language assessment using objects, picture boards, and storytelling tasks, was administered in Soninke (and in French for children in France) to migrant children in France and to children in Mauritania, with standardized procedures to minimize distractions and ensure comfort. All sessions were recorded, de-identified, and supplemented with field notes and a logbook to capture contextual and qualitative elements of children's language use. The results of the two groups of children were analyzed and compared with quantitative and qualitative methods. Given the excellent results of the monolingual children, the ELAL in the Soninke language can be considered valid. Statistical analysis confirmed significant differences between the children's scores in Mauritania and France, for both the total score and each separate scale (Comprehension, Expression, and Storytelling). The results also showed that the quality of the narrative skills (storytelling) was strongly correlated with the child's age. Comparing the language assessments collected in these two settings highlights the variations and cultural specificities that should be considered when studying the language skills of Soninke-speaking migrant children.

This study explores the frictions between state-imposed affective norms and individual emotional realities during the COVID-19 pandemic in Shanghai, focusing on the lived experiences of psychological counsellors. Based on ethnographic research, it examines how the Chinese state's promotion of positive psychology operated as a tool of affective governance, framing gratitude, hope, and optimism as civic virtues amid widespread hardship. During extended confinement, food shortages, and restricted healthcare access, counsellors encountered pervasive anxiety, depression, and anger in both their clients and themselves-emotions at odds with the state's emotionally prescriptive narratives. Trained to validate and explore "negative" emotions, counsellors responded in divergent ways: while some affirmed the state-promoted discourse of positivity as a form of coping or professional compliance, others challenged it by attending to the dissonant emotional experiences around them. The concept of affective dissonance serves as the central analytic tool in this article, revealing how emotional misalignment in this context is not merely psychological but also political and structural. For those who resisted, affirming disallowed affects became a mode of preserving self-integrity, fostering solidarity, and opening space for critique. In authoritarian settings where emotions are ideologically scripted, acknowledging dissonant affects becomes central to both therapeutic practice and political consciousness.

Singapore's mental health peer movement is a social movement that encourages persons with psychiatric histories to use their lived experience for the benefit of others. This is a rare state-led intervention designed to empower persons in recovery to advocate for themselves and exercise agency. However, in the context of a depoliticized society such as Singapore, the inherently political nature of this work-to articulate a shared identity, build community and awareness, and press for destigmatization and other forms of support-has become obscured, thereby muting the potential of the peer movement. This article discusses life-writing narratives as an opportunity to advance the re-politicization of mental health stories. I argue from an insider's perspective that life-writing provides an opportunity within Singapore's mental health landscape for a diverse range of stories to be told that may complicate dominant narratives in mental health.

This paper explores the significant role of lived experience in shaping mental health advocacy and research initiatives in Indonesia, both now and in the foreseeable future. It offers a comprehensive examination of the author's journey as a mental health advocate, encompassing local and global contexts. The author's ongoing projects and their role as an advisory board member for various groups are discussed, highlighting the valuable insights gained from lived experience. Their roles include active participation in mental health user organizations, peer support, and mental health non-governmental organizations (NGOs). The paper also underscores the presence of mental health user movements and the active engagement of multiple organizations dedicated to advocating for mental health issues in Indonesia. These movements and organizations collectively work to address and enhance mental health concerns across the nation. Despite their valuable contributions, these mental health movements and NGOs face financial challenges due to the scarcity of government funding and the shortage of mental health professionals in Indonesia. The paper emphasizes the need for greater recognition and financial support for these organizations to strengthen the country's mental health services and advocacy.

This qualitative study explored the relationship between experiences of stigma and discrimination, and internalized stigma in people with severe mental disorders residing in Gran Concepción, Chile. Twelve participants were selected from a secondary care health center through a maximum variation sampling. Data were collected using semi-structured in-depth interviews, followed by reflective thematic analysis. Responses addressed four themes: 1) perception of the diagnosis; 2) perception and experiences of stigmatization and discrimination; 3) self-perception and internalized stigma; and 4) work. Most participants conceptualized psychiatric diagnoses in negative terms and reported experiences of stigmatization in the family, school, community, work, and health environments. However, only those exposed to stigma in the health area described internalized stigma. This finding highlights the paradoxical role of health services, which, instead of functioning solely as spaces of support and treatment, may also become central settings for the development of internalized stigma, underscoring the need to critically review institutional and professional practices. The study suggests that experiences in the health services may be crucial for the development of internalized stigma.